exam 3

PSYC 4450 Abnormal Psychology Study Guide

Chapter 8: Eating and Sleep-Wake Disorders

Eating Disorders

Anorexia Nervosa

What it is: An eating disorder characterized by extreme weight loss, restriction of calorie intake below energy requirements, intense fear of gaining weight, and a distorted body image.

DSM-5 Criteria:

• Restriction of energy intake leading to significantly low body weight (15% below expected weight).

• Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain.

• Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of low body weight.

Examples: Excessive dieting, compulsive exercise, possible binging and purging behaviors.

Causes: Combination of genetic predisposition, sociocultural factors emphasizing thinness, psychological factors such as perfectionism and low self-esteem, and biological factors (e.g., neurotransmitter imbalances).

Treatment: Goals include weight restoration, psychoeducation, cognitive-behavioral interventions targeting eating behavior and body image, often involving family therapy. Prognosis poorer than bulimia when untreated.

Prevalence/Statistics: Majority female and white; onset in early adolescence; lifetime prevalence approximately 1%; most deadly mental disorder due to physical complications.

Bulimia Nervosa

What it is: An eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors such as purging, fasting, or excessive exercise, with an excessive concern about body shape and weight.

DSM-5 Criteria:

• Recurrent episodes of binge eating (consuming large amounts of food with a sense of lack of control).

• Recurrent inappropriate compensatory behaviors to prevent weight gain (e.g., vomiting, laxatives, fasting, or excessive exercise).

• Binge eating and compensatory behaviors occur at least once a week for three months.

• Self-evaluation is excessively influenced by body shape and weight.

Examples: Eating high-fat, high-sugar foods in secret, frequent purging.

Causes: Sociocultural pressures toward thinness, biological factors such as serotonin deficits, psychological factors including mood intolerance and low personal control.

Treatment: Cognitive-behavioral therapy (CBT) is the treatment of choice; antidepressant medications may reduce binging and purging.

Prevalence/Statistics: 90%+ female; onset in adolescence; lifetime prevalence about 1.1% for females; tends to be chronic if untreated.

Binge Eating Disorder

What it is: Recurrent episodes of binge eating without compensatory behaviors, often associated with distress and functional impairment.

DSM-5 Criteria:

• Recurrent binge eating episodes involving large food intake and lack of control.

• Marked distress regarding binge eating.

• Binge eating occurs at least once a week for three months.

• No regular compensatory behaviors present.

Examples: Episodes of overeating high-calorie foods, feelings of guilt afterward.

Causes: Combination of genetic, psychological (e.g., mood disturbance), and sociocultural factors.

Treatment: Cognitive-behavioral therapy, interpersonal psychotherapy, self-help techniques.

Prevalence/Statistics: More common in older individuals than anorexia or bulimia; many sufferers are obese; associated with greater psychopathology than obese non-bingers.

Obesity

What it is: Condition of excessive body fat, often resulting from an imbalance of caloric intake and expenditure; not a DSM disorder but associated with physical and mental health problems.

Causes: Genetic predisposition (~30%), technological/societal factors, behavioral and psychosocial contributors.

Treatment: Progressive approach including self-directed weight loss, commercial programs, behavior modification, and bariatric surgery.

Statistics: Over 30% of US adults are obese; associated with increased mortality rates comparable to smoking.

Sleep-Wake Disorders

Insomnia Disorder

What it is: Difficulty initiating or maintaining sleep, or early morning awakening with inability to return to sleep, despite adequate opportunity.

DSM-5 Criteria:

• Predominant complaint of dissatisfaction with sleep quantity or quality with difficulty initiating/maintaining sleep or early awakening.

• Occurs ≥3 nights per week for ≥3 months.

• Causes clinically significant distress or impairment.

• Not explained by other disorders or substances.

Causes: Often associated with psychological or medical conditions, negative sleep-related beliefs, unrealistic expectations of sleep.

Treatment: Cognitive-behavioral therapy for insomnia (CBT-I), relaxation training, stimulus control, sleep hygiene education.

Statistics: Affects females twice as often as males; 35% report daytime sleepiness.

Hypersomnolence Disorder

What it is: Excessive sleepiness despite a main sleep period lasting ≥7 hours, including prolonged sleep episodes or recurrent naps.

DSM-5 Criteria:

• Excessive sleepiness ≥3 times per week for ≥3 months.

• Causes distress or impairment.

• Not better explained by other disorders or substance use.

Treatment: Stimulant medications such as Ritalin.

Statistics: Often associated with medical/psychological conditions.

Narcolepsy

What it is: Recurrent, irresistible need to sleep, lapses into sleep or naps, accompanied by cataplexy (sudden loss of muscle tone), hypocretin deficiency, or abnormal REM sleep onset.

DSM-5 Criteria:

• Recurrent periods of sleepiness ≥3 times/week for 3 months.

• Presence of cataplexy, hypocretin deficiency, and/or REM latency ≤15 minutes.

Treatment: Stimulants for daytime sleepiness, antidepressants for cataplexy.

Statistics: Rare (0.03%-0.16%), equal male/female distribution, onset during adolescence, typically improves over time.

Breathing-Related Sleep Disorders

Types: Obstructive sleep apnea hypopnea (airflow stops despite respiratory effort), central sleep apnea (lack of respiratory effort), and sleep-related hypoventilation.

DSM-5 Criteria: Polysomnographic evidence of abnormal breathing events causing sleep disruption and daytime impairment.

Causes/Associated Features: Linked to obesity, age, male sex; symptoms include snoring, daytime sleepiness, and morning headaches.

Treatment: Weight loss, mechanical devices (CPAP), medications.

Circadian Rhythm Sleep-Wake Disorder

What it is: Sleep disruption resulting from misalignment between the endogenous circadian rhythm and the required sleep-wake schedule (e.g., shift work).

DSM-5 Criteria: Persistent or recurrent pattern causing distress or impairment.

Treatment: Phase delay/advance strategies, bright light therapy.

Parasomnias

Non-REM Sleep Arousal Disorder (Sleep Terrors & Sleepwalking)

Sleep Terrors: Panic-like episodes during non-REM sleep, mostly in children, with little memory of the event.

Sleepwalking: Ambulation during non-REM sleep, usually in children, often resolves without treatment.

Treatment: Scheduled awakenings; severe cases may use antidepressants or benzodiazepines.

Nightmare Disorder

What it is: Repeated dysphoric, well-remembered dreams awakening the individual, leading to distress or impairment.

Treatment: Antidepressants, relaxation training.

REM Sleep Behavior Disorder

What it is: Repeated episodes of sleep arousal with vocalization and/or complex motor behavior during REM sleep, sometimes causing injury.

Treatment: Not specified in provided text; associated with neurodegenerative disorders.

Chapter 9: Sexual Disorders, Gender Dysphoria, and Paraphilic Disorders

Sexual Dysfunctions

Involve problems with desire, arousal, orgasm, or pain during sex. Must be present for ≥6 months and cause distress or impairment.

Male Hypoactive Sexual Desire Disorder

What it is: Little or no sexual interest or desire; rare sexual fantasies or activity.

DSM-5 Criteria:

• Persistently deficient sexual thoughts, fantasies, and desire (clinical judgment considers age and context).

• Symptoms for at least 6 months causing distress.

• Not better explained by other mental, medical issues, or substance effects.

Prevalence: Affects about 5% of men; accounts for half of complaints at sexuality clinics.

Female Sexual Interest/Arousal Disorder

What it is: Lack or significant reduction of sexual interest/arousal.

DSM-5 Criteria: At least three symptoms including reduced interest, fewer sexual thoughts, lack of initiation, decreased pleasure or arousal, lasting ≥6 months with distress.

Female Orgasmic Disorder

What it is: Marked delay, infrequency, or absence of orgasm, or reduced intensity in most sexual encounters.

Prevalence: About 25% of women experience difficulties.

Genito-Pelvic Pain/Penetration Disorder

What it is: Difficulty with vaginal penetration, pain, fear of pain, or pelvic muscle tightness during intercourse.

Premature Ejaculation

What it is: Ejaculation within about 1 minute of penetration, occurring before desired, causing distress.

Prevalence: Affects 21% of adult males, most common in younger men.

Erectile Disorder

What it is: Difficulty achieving or maintaining an erection despite intact sexual desire.

Prevalence: Most common sexual problem in men; prevalence increases with age (about 60% of men over 60 affected).

Causes of Sexual Dysfunction

• Biological: diseases, medications, substance use.

• Psychological: anxiety, negative thoughts, avoidance of sexual cues.

• Social/Cultural: erotophobia, traumatic sexual experiences, poor relationships.

Treatment

• Education and counseling (Masters and Johnson approach, sensate focus exercises).

• Psychosocial methods: squeeze technique, masturbatory training, use of dilators.

• Medical: Viagra and other medications; limited options for female dysfunction.

Paraphilic Disorders

Involves inappropriate sexual attraction and arousal. Diagnosed when distress/impairment or harming nonconsenting others occurs.

Fetishistic Disorder

What it is: Sexual arousal from nonliving objects or non-genital body parts over ≥6 months causing distress or impairment.

Examples: Rubber, hair, feet, shoes.

Frotteuristic Disorder

What it is: Sexual arousal from touching or rubbing against a nonconsenting person, often in crowded places.

Voyeuristic Disorder

What it is: Sexual arousal from observing unsuspecting individuals undress or engage in sexual activity.

Exhibitionistic Disorder

What it is: Sexual arousal from exposing genitals to unsuspecting strangers.

Transvestic Disorder

What it is: Sexual arousal from cross-dressing for at least 6 months causing distress or impairment.

Sexual Sadism and Masochism Disorders

• Sexual Sadism: Arousal by inflicting pain or humiliation on others.

• Sexual Masochism: Arousal by receiving pain or humiliation.

Pedophilic Disorder

What it is: Sexual attraction to prepubescent children. Majority are males. Sometimes limited to incestuous attractions.

Causes of Paraphilic Disorders

• Difficulty forming typical relationships.

• Early sexual associations reinforced by masturbation.

• Often high sex drive; suppression can increase paraphilic thoughts.

Treatment

• Psychosocial: behavioral techniques (covert sensitization, orgasmic reconditioning), family therapy, relapse prevention.

• Drug treatments ("chemical castration") to reduce testosterone in dangerous offenders.

Gender Dysphoria

Marked incongruence between experienced gender and assigned sex with associated distress or impairment.

DSM-5 Criteria for Children

At least six symptoms over 6 months (e.g., strong desire to be other gender, cross-dressing preferences, rejection of typical gender toys, dislike of anatomy), plus distress or impairment.

DSM-5 Criteria for Adolescents and Adults

At least two symptoms over 6 months, including strong desire to be other gender, desire to change sex characteristics, or feel typical feelings of other gender, with distress or impairment.

Treatment

• Sex reassignment surgery after psychological and social stability and living as desired gender for years.

• Some psychological treatment controversy, especially in children.

• Intersexuality often addressed surgically at birth, with possible later psychological treatment.

Chapter 10: Substance-Related, Addictive and Impulse-Control Disorders

Substance-Related Disorders

Involve abuse, dependence, intoxication, withdrawal, and use disorders associated with various classes of drugs:

DSM-5 Substance Use Disorder Criteria

• Pattern of use leading to impairment/distress.

• At least 2 symptoms in 12 months including: larger amounts used than intended, unsuccessful efforts to cut down, craving, failure in major roles, hazardous use, tolerance, withdrawal, etc.

Alcohol Use Disorder

Effects: CNS depressant via GABA. Causes intoxication, withdrawal, dementia, fetal alcohol syndrome.

Statistics: 3 million dependents in US; higher use among Caucasians and males; 23% binge drink.

Sedative, Hypnotic, or Anxiolytic Use Disorder

Similar effects and criteria as alcohol; act via GABA system.

Stimulant Use Disorders

Include amphetamines, cocaine, nicotine, caffeine.

• Amphetamines produce elation by enhancing norepinephrine/dopamine.

• Cocaine blocks dopamine reuptake; highly addictive.

• Nicotine highly addictive with mood-relaxing effects.

• Caffeine most widely used; can cause intoxication with restlessness, insomnia.

Opioid Use Disorder

Activate opioid receptors causing euphoria, drowsiness; withdrawal severe; high risk of HIV.

Hallucinogen Use Disorder

Include marijuana and LSD; marijuana effects include mood swings and rare withdrawal.

Other Drugs of Abuse

• Inhalants: volatile solvents causing intoxication.

• Anabolic steroids: mood disturbances, physical problems.

• Designer drugs: e.g., ecstasy, ketamine causing altered perception.

Causes of Substance-Related Disorders

• Genetic: familial and twin studies show hereditary components.

• Neurobiological: drugs affect brain reward pathways (dopaminergic system).

• Psychological: positive and negative reinforcement, opponent-process theory, expectancy effects.

• Social/Cultural: exposure, parental influence, cultural attitudes.

Treatments

• Biological: agonist substitution (methadone), antagonists (naltrexone), aversive treatments (antabuse).

• Psychosocial: inpatient/outpatient therapy, community support (AA), CBT, contingency management, relapse prevention.

Gambling Disorder

What it is: Recurrent problematic gambling behavior causing distress or impairment.

DSM-5 Criteria: At least 4 of 9 symptoms within 12 months including tolerance, withdrawal, preoccupation, unsuccessful attempts to cut down, jeopardizing relationships or jobs, relying on others financially.

Treatment: Similar to substance abuse treatment; motivational factors critical; high dropout rates; CBT under investigation.

Impulse-Control Disorders

• Intermittent Explosive Disorder: Repeated aggressive outbursts causing injury.

• Kleptomania: Urge to steal unnecessary items; comorbid with mood and substance disorders.

• Pyromania: Urge to set fires; rare; treatment focuses on urge identification and incompatible behaviors.

Exam 3 Discussion Questions and Answers

1. List the five categories of substances and their effect on the central nervous system. Provide an example substance from each category.

• Depressants: Cause behavioral sedation and CNS depression. Examples: Alcohol, benzodiazepines.

• Stimulants: Increase alertness and elevate mood by stimulating CNS. Examples: Cocaine, nicotine, amphetamines, caffeine.

• Opioids: Produce analgesia and euphoria by activating opioid receptors. Examples: Heroin, morphine, codeine.

• Hallucinogens: Alter sensory perception and can produce hallucinations or delusions. Examples: Marijuana (cannabis), LSD.

• Other Drugs of Abuse: Varied effects; include inhalants and anabolic steroids. Examples: Inhalants (paint thinner), anabolic steroids.

2. List the five phases in the human sexual response cycle. While you do not need to know the specific disorders, explain how disorders associated with this cycle are different than paraphilic disorders.

• Phases of Sexual Response Cycle:

  1. Desire

  2. Arousal

  3. Plateau

  4. Orgasm

  5. Resolution

• Difference in Disorders: Sexual dysfunctions involve impairments in one or more phases of the normal sexual response cycle (e.g., lack of desire, difficulty with arousal or orgasm, pain). These disorders cause distress or impairment related to normative sexual behavior.

• Paraphilic disorders, on the other hand, involve sexual attraction or behaviors focused on inappropriate or non-normative objects, situations, or individuals, often involving nonconsenting partners, and may not be linked to the sexual response cycle phases.

3. Define paraphilia. List and define four paraphilic disorders with an example of each.

Paraphilia: A condition where sexual attraction or arousal is directed toward inappropriate people or objects and is considered disordered if it causes distress/impairment or involves nonconsenting individuals.

• Fetishistic Disorder: Sexual arousal from nonliving objects or specific nongenital body parts (e.g., shoes or feet).

• Voyeuristic Disorder: Sexual arousal from observing unsuspecting individuals undressing or engaging in sexual activity.

• Exhibitionistic Disorder: Sexual arousal from exposing one’s genitals to unsuspecting strangers.

• Pedophilic Disorder: Sexual attraction to prepubescent children.

4. Define each disorder and then discuss how each of the following pairs are similar and then different from each other:

a. Fetishistic Disorder vs. Transvestic Disorder

Definitions:

• Fetishistic Disorder: Sexual arousal from nonliving objects or specific nongenital body sites that are not articles of clothing used for cross-dressing.

• Transvestic Disorder: Sexual arousal from cross-dressing (wearing clothing of the opposite sex).

Similarities: Both involve atypical sexual arousal focused on inanimate objects or clothing and can cause distress or impairment.

Differences: Fetishistic disorder’s focus is on objects or body parts excluding clothing for cross-dressing, whereas transvestic disorder specifically involves cross-dressing behaviors. Transvestic disorder is also typically associated with males and may include specific subtypes like fetishism or autogynephilia.

b. Transvestic Disorder vs. Gender Dysphoria

Definitions:

• Transvestic Disorder: Sexual arousal related to cross-dressing; identity remains consistent with assigned gender.

• Gender Dysphoria: Marked incongruence and distress between experienced gender identity and assigned sex.

Similarities: Both involve cross-gender behaviors or expressions.

Differences: Transvestic disorder is characterized primarily by sexual arousal through cross-dressing without desire to change gender identity, while gender dysphoria involves a profound and persistent identification with the opposite gender and desire to transition or live as that gender, not primarily driven by sexual arousal.

5. Briefly describe bulimia nervosa and anorexia nervosa. List and describe the two subtypes of anorexia nervosa. Give one primary difference between the two disorders.

Bulimia Nervosa: Characterized by recurrent binge eating episodes followed by compensatory behaviors (e.g., purging), with undue influence of body shape on self-worth. Patients usually maintain normal or near-normal weight.

Anorexia Nervosa: Characterized by significant weight loss due to caloric restriction or binging/purging, with intense fear of weight gain and distorted body image.

Subtypes of Anorexia Nervosa:

• Restricting Type: Weight loss primarily through dieting, fasting, or excessive exercise without regular binge-purge episodes.

• Binge-Eating/Purging Type: Regular episodes of binge eating or purging behavior (e.g., vomiting, laxatives) in addition to weight loss.

Primary Difference: Bulimia involves normal or fluctuating weight with binge-purge cycles, whereas anorexia involves significant low weight and can include either restriction or binge-purge subtypes.