Eating, Personality, Addictive, Sexual, Somatic Symptom and Dissociative Disorders

Eating Disorders

  • Definition: Persistent disturbance in eating or eating-related behavior leading to altered food consumption/absorption and impaired physical health or psychosocial functioning.

Anorexia Nervosa

  • Definition: Relentless pursuit of thinness, fear of gaining weight, and body image disturbance.

  • Diagnostic Criteria:

    • Weight less than 85% of expected or BMI < 17 (adults).

    • Intense fear of weight gain.

    • Cognitive distortions regarding body image.

  • Subtypes:

    • Restricting type: No binge eating or purging.

    • Binge eating/purging type: Regular engagement in binge eating or purging.

  • Severity Specifiers (BMI for adults):

    • Mild: BMI > 17

    • Moderate: BMI 16–16.99

    • Severe: BMI 15–15.9

    • Extreme: BMI < 15

  • Potential Contributing Factors:

    • Biological: Neuroendocrine abnormalities (e.g., leptin), decreased brain volume.

    • Psychological: Low self-esteem, dysfunctional thoughts, clinical perfectionism, interoceptive deficits, maturity fears.

    • Social: Family dynamics (criticism, low emotional care), sociocultural pressures for thinness.

  • Treatment:

    • Cognitive Behaviour Therapy (CBT): Normalizing eating, weight, and weight-control behaviors.

Bulimia Nervosa

  • Recurrent binge eating episodes with a perception of lack of control.

  • Inappropriate compensatory behavior.

  • Occurring at least twice per week over three months.

  • Self-evaluation unduly influenced by body shape and weight.

  • Not exclusively during anorexia nervosa.

  • Dieting is a risk factor.

Personality Disorders

  • Organized into three clusters (A, B, C) based on similar traits.

Cluster A

  • Odd or eccentric traits.

  • Includes paranoid, schizoid, and schizotypal personality disorders.

  • Mistrusting, introverted, and difficult to engage in treatment.

  • Genetic link to schizophrenia.

Cluster B

  • Dramatic, emotional, or erratic traits.

  • Includes antisocial, borderline, histrionic, and narcissistic personality disorders.

  • Challenging behaviors such as aggression, self-harm, and inappropriate advances.

Cluster C

  • Anxious and fearful traits.

  • Includes avoidant, dependent, and obsessive-compulsive personality disorders.

  • Anxious, avoidant, and dependent presentations.

Core Features of Personality Disorder

  • Functional inflexibility.

  • Self-defeating behavior patterns.

  • Instability under stress.

Addictive Disorders

  • Divided into substance use disorders and substance-induced disorders.

  • Classified on a continuum from mild (2-3 criteria) to severe (6+ criteria).

  • Harmful use: Pattern of substance use causing physical or psychological harm.

  • Substance dependence: Three or more criteria (strong desire, impaired control, withdrawal, tolerance, preoccupation, persistent use).

  • Gambling Disorder: Addictive classification.

Theories of Addictive Disorders

  • Impaired Control vs. Choice: Loss of control is central; disease model describes addiction as a brain impairment.

  • Biological Factors: Substances affect brain's reward systems (dopaminergic, opioid).

  • Psychological Factors:

    • Behavioral: Instrumental learning model.
      Cognitive: Outcome expectancy, PRIME theory

Diagnosis

  • At least 2 symptoms within 12 months causing distress or impairment.

Somatic Symptom and Dissociative Disorders

Somatic Symptom and Related Disorders

  • Somatic symptoms with excessive concerns.

    • Somatic Symptom Disorder: Distressing symptoms with abnormal thoughts/behaviors lasting at least six months.

    • Illness Anxiety Disorder: Preoccupation with serious illness, high health anxiety lasting at least six months.

    • Conversion Disorder: Disturbance in motor/sensory functioning.

    • Psychological Factors Affecting Other Medical Conditions: Psychological factors negatively impacting a medical condition.

    • Factitious Disorder: Deliberately feigning illness to gain medical attention.

Dissociative Disorders

  • Disruption in integration of identity, memory, perception, etc.

    • Depersonalization/Derealization Disorder: Feelings of detachment from self/world.

    • Dissociative Amnesia: Loss of memory of personal information related to trauma.

    • Dissociative Identity Disorder (DID): Two or more distinct identities.

Sexual Disorders

  • Impairment in desire, arousal, or orgasm.

Sexual Dysfunctions

  • Desire Phase: Hypoactive sexual desire disorder.

  • Arousal Phase: Erectile disorder, female sexual arousal disorder.

  • Orgasm Phase: Delayed ejaculation, premature ejaculation, female orgasmic disorder.

  • Classified by onset, context, and severity.

Paraphilic Disorders

  • Sexual activities/interests outside genitally focused activities with consenting partners; cause distress or harm.
    Exhibitionistic, fetishistic, frotteuristic, paedophilic, sexual masochistic/sadistic, transvestic, voyeuristic disorders.

General Diagnostic Criteria for Paraphilic Disorders

  • Must have acted on urges with a non-consenting person, or urges cause clinically significant distress.


Exhibitionistic disorder involves exposing one's genitals to an unsuspecting stranger.

Fetishistic disorder involves intense sexual arousal from nonliving objects or specific body parts. Frotteuristic disorder is when a person has urges to touch or rub against a non-consenting person.

Paedophilic disorder involves sexual attraction to prepubescent children.

Sexual masochistic disorder involves sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer.

Sexual sadism disorder involves sexual arousal from the physical or psychological suffering of another person.

Transvestic disorder involves cross-dressing for sexual arousal.

Voyeuristic disorder involves observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity.