181 Questions
What percentage of middle and high school girls reported problems with body image?
41.5%
What percentage of middle and high school boys reported problems with body image?
24.9%
What is the purported role of personal (eating) choices/habits in appearance/weight?
Strongly emphasized
What does the AMA disavow as a measure of individual health?
BMI
What is the immediate goal in (severe) AN treatment?
Stabilizing and/or increasing weight to address acute health concerns
What is the recommended length of treatment for AN?
1-2 years
What is the focus of Family-Based Therapy (FBT) for AN?
Anorexia viewed as an interpersonal (vs. individual) problem
What is the role of medication in the treatment of AN?
Antidepressants can be helpful for some with BN, but no strong evidence they are effective for AN
What is the common 'side effect' of Vyvanse in the treatment of BED?
Decreased appetite
What is the focus of prevention efforts for eating disorders?
Confronting and de-emphasizing unrealistic beauty standards, diet culture, etc.
What is the percentage of patients with severe eating disorders committed to a hospital for treatment against their will?
15%
What is the potential benefit of adding ERP to CBT in the treatment of eating disorders?
It can increase efficacy of CBT, at least in the short term
What is the recommended treatment intensity for AN?
High intensity, individual treatment
What is the potential role of olanzapine in the treatment of AN?
It can be beneficial
What is the focus of cognitive behavioral therapy (CBT) in the treatment of eating disorders?
Challenging societal ideals of thinness; beliefs about food, dieting, and weight
What is the focus of psychoeducational approaches in the prevention of eating disorders?
Early education about the dangers of eating disorders
What is linked to reinforced restricted eating and compulsive exercise in Anorexia Nervosa (AN)?
Low levels of endogenous opioids (endorphins)
What is related to feelings of satiety and low levels of its metabolites are found in Anorexia Nervosa (AN)?
Serotonin
What are partially heritable in terms of eating disorders?
Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation
What is linked to difficulties in emotion regulation and feelings of self-control in individuals with eating disorders?
Patterns of reinforcement such as restricted eating, excessive exercise, and binges
What is not specific to eating disorders but may precede disordered eating in some cases?
High levels of family conflict and low levels of family support
What plays a role in the development of eating disorders according to the text?
Diet culture, intense weight stigma, and gender objectification
What is at greater risk for major depression, substance use disorders, and OCD?
Relatives of those with eating disorders
What is strongly genetically overlapped with eating disorders according to the text?
OCD, schizophrenia, negative affectivity, and metabolic factors
What is not specific to eating disorders but contributes to disordered eating and poor mental health?
Unrealistic media portrayals of bodies and weight stigma
Who is less likely to seek treatment for eating disorders according to the text?
Men and people with higher BMIs
What are individuals with eating disorders often pessimistic about according to the text?
Their potential for recovery
What is the lifetime prevalence of Anorexia Nervosa (AN) in the US?
1%
At what age does Anorexia Nervosa (AN) typically have an average onset?
14-20
What is the worldwide lifetime prevalence of Binge Eating Disorder (BED)?
2%
In which gender is Binge Eating Disorder (BED) more common?
Women
What is one of the most medically dangerous diagnoses in the DSM, with mortality rates 5-10x higher than the general population?
Anorexia Nervosa (AN)
What percentage of individuals with Anorexia Nervosa (AN) recover?
50-75%
What is the worldwide lifetime prevalence of Bulimia Nervosa (BN)?
1%
At what age does Bulimia Nervosa (BN) typically have an average onset?
15-24
What percentage of individuals with Bulimia Nervosa (BN) recover?
75-90%
What does Binge Eating Disorder (BED) involve?
Frequent binging without compensatory behaviors
What is the gender ratio for Anorexia Nervosa (AN) in the US?
3+:1
Which trait is associated with being outgoing and sociable?
Extraversion
Which trait is associated with being somewhat careless?
Conscientiousness
Which trait is associated with being helpful and unselfish with others?
Agreeableness
Which trait is associated with worrying a lot?
Negative Affectivity (Neuroticism)
What is the Diathesis of biologically grounded emotion dysregulation in Linehan’s “Biopsychosocial Model” primarily influenced by?
Genetic vulnerability
What is the characteristic of Avoidant PD as compared to Social Anxiety Disorder according to Chambless et al. (2008)?
More severe and chronic
What is the Ironic effect mentioned in the text?
Behaviors aimed at seeking validation often produce rejection
What is the analogy used to describe people with BPD in the text?
People with BPD are like people with third degree burns over 90% of their bodies
What did DSM-5 consider but ultimately declined to do regarding psychopathy features?
Incorporating more psychopathy features into diagnostic criteria
Which myth about psychopathy and prison is debunked?
People in prison are less likely to meet DSM ASPD criteria than Cleckley’s criteria for psychopathy
What does research on psychopathy historically suffer from?
Biased sampling
What is a moderately heritable trait that overlaps with risk for substance use problems?
Psychopathy
What is the strongest predictor of adult ASPD diagnoses?
Number of antisocial behaviors in childhood
What do GxE interactions in ASPD refer to?
Interaction between genetic and environmental factors
What are environmental risk factors for psychopathy?
Parental rejection, abuse, neglect, and inconsistent discipline
What are the facets of narcissism?
Grandiosity and vulnerability
What is the focus of prevention efforts for psychopathy?
Early intervention for childhood antisocial behaviors
What is the role of biological parents in shaping offspring’s lives?
Through genes and shaping early environments
What did research on psychopathy historically suffer from?
Biased sampling
What is a risk factor for ASPD?
Exposure to violence in the family environment
What is the lifetime prevalence of personality disorders in the past 2-5 years?
10-12%
What is the primary factor contributing to the etiology of personality disorders?
Genetic contributions
What percentage of individuals with personality disorders meet criteria for another PD?
Over 50%
What is a common diagnosis for individuals who seem to meet the broad criteria for a personality disorder but don't meet criteria for any specific PD?
Unspecified Personality Disorder (UPD)
What is a significant issue with the current DSM approach to personality disorders?
Lack of integration with modern personality science
What is the stability of personality disorders compared to other classes of disorders?
Not especially stable
What is the diagnostic category for individuals who need to endorse 5 of 9 criteria for diagnosis?
Borderline Personality Disorder (BPD)
What is a common issue with the diagnostic criteria for personality disorders?
Too broad
What is the primary factor contributing to diagnostic unreliability of personality disorders?
Imprecise criteria
What is the primary challenge posed by the high rate of comorbidity with other DSM disorders?
Diagnostic overlap in symptoms
What is the primary challenge in the current approach to diagnosing personality disorders?
Lack of integration with modern personality science
What percentage of individuals diagnosed with BPD report at least one suicide attempt?
Almost 70%
What is the gender ratio of individuals diagnosed with BPD in clinical settings?
75% women
What are the core dimensions included in a dimensional model of BPD?
Emotion dysregulation, self-identity disturbance, and interpersonal problems
What is the focus of the DSM-5 working group's BPD proposal?
Criteria for self/interpersonal impairment and pathological personality traits
What is associated with high rates of non-suicidal self-injurious behavior?
BPD
What is the approximate percentage of individuals diagnosed with BPD who end their lives by suicide?
8-10%
What may confer predisposition to temperament and personality traits associated with BPD?
Genes
What is evident in individuals with BPD according to evidence?
Diminished connectivity of brain regions involved in emotion experience and regulation
What are highly correlated with BPD according to the text?
Environmental risk factors such as childhood maltreatment and abuse
What is the proposed role of olanzapine in the treatment of BPD?
Emotion regulation
What is the focus of psychoeducational approaches in the treatment of BPD?
Interpersonal challenges and consequences
What are individuals with BPD more likely to have compared to the general population?
High comorbidity with other disorders such as mood, anxiety, substance use, and eating disorders
What did the DSM-5 committee recommend for identifying and describing personality disorders?
A shift towards a dimensional system
How many personality disorders did the AMPD reduce the number to?
6 out of 10
What does the AMPD focus on in relation to long-standing dysfunction?
How personality traits might explain difficulties
How many broad trait domains does the AMPD emphasize?
5
What do the dimensions in the AMPD provide in comparison to traditional methods?
More specificity
How was the AMPD proposal received by the DSM-5 Task Force?
Rejected
How many comments were received during two months of public comments on the AMPD proposal?
Approximately 8,600
What was one of the criticisms faced by the AMPD proposal?
Complex and incoherent
What was the AMPD proposal criticized for in terms of the group of disorders?
Eliminating half of the group of disorders
What was the AMPD not the only one of?
Alternative framework or dimensional model proposed for personality disorders
What did the proposal generate debate about in terms of the ethics of conceptualizing and diagnosing personality disorders?
The stigma associated with personality disorders
What did the text discuss specifically in relation to personality disorders?
Schizotypal and psychopathy, and their overlap and differences with other disorders
What did the DSM-5 committee recommend for identifying and describing personality disorders?
A dimensional system
How many personality disorders did the AMPD reduce to from the DSM-IV PDs?
6
What does the AMPD focus on in relation to dysfunction and personality traits?
Long-standing dysfunction and how personality traits might explain these difficulties
How many broad trait domains are emphasized in the AMPD?
5
What do the dimensions in the AMPD provide in comparison to the previous system?
More specificity, richer index of 'how much', and higher internal consistency and test-retest stability
How was the AMPD proposal received by the DSM-5 Task Force?
Rejected and relegated to an obscure appendix
What was a criticism of the AMPD proposal?
Being complex and incoherent, with concerns about its clinical utility
What was the criticism related to the number of disorders eliminated by the AMPD?
Eliminating half of the group of disorders
What was the response of the proposal generating debate about the ethics of conceptualizing and diagnosing personality disorders?
It generated debate about the ethics of conceptualizing and diagnosing a person’s 'personality' as 'disordered'
What is the AMPD in relation to other proposed frameworks for personality disorders?
Not the only alternative framework or dimensional model proposed
What did the rejection of the AMPD generate in terms of feedback?
Significant pushback, with approximately 8,600 comments received during two months of public comments
What are the specific personality disorders discussed in the text?
Schizotypal and psychopathy, and their overlap and differences with other disorders
Which substance was available in Europe around 10,000 years ago?
Opium
In what region were coca leaves chewed for cocaine around 8,000 years ago?
Peru
Which of the following substances is listed in the DSM-5?
Cannabis
Which quote reflects a struggle with alcohol use disorder?
“Alcohol ruined me financially and morally...” – Craig Ferguson
What is the primary focus of AA/NA treatment?
Abstinence
Why is it challenging to conduct research on the effectiveness of AA?
Emphasis on anonymity
What is the reported effectiveness of AA based on?
Anecdotal information
What is the focus of harm reduction programs in the context of substance use?
Reducing the negative consequences of substance use
What is the 'Drunken monkey hypothesis' related to?
Evolution of human brain
In the long-term, what reinforces and maintains substance use?
Activation of dopamine circuits
When is the human brain most vulnerable to the long-term effects of drugs?
During adolescence
What is historically separated out from other psychopathologies?
Substance use
Which term is associated with biochemical changes affecting neuronal sensitivity in substance use disorders?
Tolerance
What does the DSM-5 combine into a single diagnosis of substance use disorder?
Substance abuse disorder and substance dependence disorder
What is responsible for over 480,000 deaths per year in the US, including nearly 30% of all cancer deaths?
Cigarette smoking
What do nearly all addictive drugs, including alcohol, stimulate in the brain?
Dopamine-mediated brain systems
What theory emphasizes the distinction between liking (pleasure) and wanting (craving) in substance use disorders?
Incentive sensitization theory
What is associated with chronic, heavy alcohol use?
Declining cognitive functioning
What plays a role in substance use disorders, with heritability estimates higher in environments with fewer constraints on behavior?
Genetic factors
What do substance use disorders involve, affecting decision-making and learning?
A bias toward non-drug-related stimuli
What is the focus of prevention efforts for substance use disorders?
Reducing exposure to drug-related cues
What is a controversial topic among researchers in the field of addiction?
Behavioral addictions
What is the variability in alcohol-related consequences not solely explained by?
The quantity of alcohol use
What is a key term associated with substance use disorders and refers to the need for higher doses to achieve the same effect?
Tolerance
What is often the initial stage of treatment for substance use disorders?
Detox
What is a common approach in the treatment of substance use disorders?
Cognitive behavioral therapies
What factor influences drinking behavior and is often established in childhood?
Alcohol expectancies
What percentage of individuals with substance use disorders receive treatment from a mental health professional?
18%
What are the treatment goals for substance use disorders?
Complete abstinence, reduced use, or harm reduction
What is a factor associated with increased substance use?
Family factors such as parental alcohol use and lack of emotional support
What type of factors contribute to substance use?
Environmental and sociocultural factors
What is a potential use of medications in the treatment of substance use disorders?
Reducing cravings or blocking receptor binding
What is an example of a developmental pathway to substance use?
Internalizing and externalizing pathways
What is the focus of effective treatment for substance use disorders?
Addressing multiple needs of the individual
What is often affiliative and influenced by peer factors and sociocultural attitudes?
Substance use
What is a potential goal of treatment for substance use disorders?
Complete abstinence
What term did Kurt Snyder use to describe his divergence from reality?
Psychotic
Who is credited with the detailed clinical description of 'dementia praecox'?
Emil Kraeplin
What did Eugen Bleuler coin in 1911?
Schizophrenia
What did Kurt Snyder wonder about his whole existence?
Whether it was manufactured by a virtual reality machine
What is the main effect of early antipsychotics?
Reduce positive and disorganization symptoms, but little or no effect on negative symptoms
What is a common property of many antipsychotic medications?
Block dopamine D2 receptors
What is a concern associated with long-term use of antipsychotics?
Their long-term effects on the brain
What is the aim of some novel medications targeting systems other than dopamine/serotonin?
To initiate downstream changes
What is recommended as a combination with medication in current treatment recommendations?
Psychosocial intervention
What is a feature not unique to schizophrenia according to the text?
Psychosis
What is schizophrenia influenced by, according to the text?
Genetics
What is the focus of prevention efforts for schizophrenia, according to the text?
Early intervention/prevention
What does the text suggest about the impairment associated with schizophrenia?
It is driven more by social factors than by schizophrenia itself
What is a challenge for schizophrenia research and clinical practice, according to the text?
Multiple etiologic pathways to a set of overlapping symptoms
What is the gender ratio of individuals diagnosed with schizophrenia in clinical settings?
Higher in males
What is the focus of effective community programs for schizophrenia, according to the text?
Facilitate recovery
What are the three main symptom clusters that characterize schizophrenia?
Positive, negative, and disorganized symptoms
What do negative symptoms of schizophrenia involve?
Reductions in motivation, pleasure, and social closeness
What are examples of positive symptoms of schizophrenia?
Delusions and hallucinations
What is the lifetime prevalence of schizophrenia?
1%
What are some consequences experienced by individuals with schizophrenia?
High rates of substance use, unemployment, housing insecurity, and incarceration
What are schizophrenia spectrum disorders that are mentioned in the text?
Schizophreniform disorder, schizoaffective disorder, and delusional disorder
What are some etiological factors mentioned in relation to schizophrenia?
High heritability, genetic vulnerability, and environmental stressors
What is the gender prevalence of schizophrenia?
Affects men slightly more often than women
What do disorganized symptoms of schizophrenia encompass?
Catatonia and disorganized behavior
What is the course of schizophrenia like among individuals?
Varies greatly among individuals
What are some of the consequences of receiving a schizophrenia diagnosis?
Profound and lasting effects on individuals' perceptions of themselves and their future
What are some of the challenges related to early detection and intervention of schizophrenia?
Varied course of the disorder among individuals
What does the revised dopamine hypothesis attribute excessive presynaptic synthesis of dopamine to?
Positive and disorganized symptoms
Which structural abnormality is observed in the prefrontal cortex in schizophrenia?
Reduction in gray matter
What is associated with worse neuropsychological performance and functioning in some individuals with schizophrenia?
Enlarged ventricles
What is found in first-degree relatives of those with schizophrenia?
High stress reactivity
What environmental influence on neurodevelopment may contribute to schizophrenia?
Maternal stress and malnutrition
What is cannabis use during adolescence associated with in relation to schizophrenia?
Greater schizophrenia risk and symptom severity
What structural and functional abnormalities are observed in individuals with schizophrenia?
Temporal cortex and reduced hippocampal volume
What is a potential contributor to loss of dendritic spines and connectivity in brain white matter observed in schizophrenia?
Early environmental influences
What may impact schizophrenia manifestations and outcomes?
Poverty and urbanicity
What does the glutamate hypothesis suggest in relation to schizophrenia?
Interactions with dopamine
What is the primary neurotransmitter implicated in the dopamine hypothesis of schizophrenia?
Dopamine
What does the genetic variants associated with risk in GWAS not fully account for in schizophrenia heritability?
Schizophrenia heritability
Study Notes
Eating Disorders: Clinical Description and Epidemiology
- Eating disorders are characterized by psychological addiction to behaviors affecting the body and mind
- Anorexia Nervosa (AN) may not cause overt distress and can be a source of personal satisfaction or pride
- "Atypical anorexia" can occur in overweight individuals, leading to underdiagnosis and treatment delays
- Binge Eating Disorder (BED) involves frequent binging without compensatory behaviors
- Many with eating disorders experience diagnostic crossover, meeting criteria for different disorders over time
- AN has a lifetime prevalence of <1% in the US, with a gender ratio of 3+:1 and an average onset of 14-20
- BN has a worldwide lifetime prevalence of ~1%, with a large gender gap and an average onset of 15-24
- BED has a worldwide lifetime prevalence of ~2%, more common in women, with a slightly later average age of onset
- Eating disorders are associated with increased risk for negative consequences and comorbidity with other mental disorders
- AN is one of the most medically dangerous diagnoses in the DSM, with mortality rates 5-10x higher than the general population
- Prognosis for AN: 50-75% recover, relapse is common, and there is a high rate of suicide
- Prognosis for BN: ~75% recover, early intervention associated with improved outcomes, and suicide attempts are made in 25-30% of cases
Reforming the Diagnosis of Personality Disorders: The AMPD and its Controversy
- The DSM-5 committee recommended a shift towards a dimensional system for identifying and describing personality disorders.
- The Alternative Model of Personality Disorders (AMPD) reduced the number of PDs to 6 out of the 10 DSM-IV PDs.
- The AMPD focuses on long-standing dysfunction and how personality traits might explain these difficulties.
- It emphasizes two types of dimensional ratings: 5 broad trait domains and 25 narrower facets of those traits.
- The dimensions in the AMPD provide more specificity, richer index of “how much” and have higher internal consistency and test-retest stability.
- The AMPD proposal was unanimously approved by the PD working group but was rejected by the DSM-5 Task Force and relegated to an obscure appendix.
- The rejection of the AMPD generated significant pushback, with approximately 8,600 comments received during two months of public comments.
- The proposal faced criticism for being complex and incoherent, with clinicians and researchers expressing concerns about its clinical utility.
- The proposal was criticized for eliminating half of the group of disorders and received opposition from those invested in the status quo.
- The AMPD is not the only alternative framework or dimensional model proposed for personality disorders.
- The proposal generated debate about the ethics of conceptualizing and diagnosing a person’s “personality” as “disordered”, and the stigma associated with personality disorders among mental health professionals and researchers.
- The text also discusses specific personality disorders, such as schizotypal and psychopathy, and their overlap and differences with other disorders.
Substance Use Disorders: Factors, Treatment, and Outcomes
- Alcohol expectancies influence drinking behavior and are often established in childhood
- Personality dimensions like negative affectivity and low constraint predict the onset of substance use disorders
- Family factors such as parental alcohol use, modeling, and lack of emotional support are associated with increased substance use
- Substance use is often affiliative, influenced by peer factors and sociocultural attitudes
- Environmental and sociocultural factors, including availability and stress, contribute to substance use
- Developmental pathways to substance use include internalizing and externalizing pathways
- Only 18% of those with substance use disorders receive treatment from a mental health professional
- Treatment goals may include complete abstinence, reduced use, or harm reduction
- Detox is often the initial stage of treatment, and medications may be used to reduce cravings or block receptor binding
- Psychotherapy, including cognitive behavioral therapies and relapse prevention training, is a common treatment approach
- Residential care can be expensive and controversial, with its effectiveness compared to outpatient care not clear
- Effective treatment should address multiple needs of the individual, including environmental factors, social relationships, and comorbid disorders
Understanding Schizophrenia: Insights into Causes and Manifestations
- Genetic variants associated with risk in GWAS do not fully account for schizophrenia heritability
- Dopamine hypothesis suggested excess dopamine levels as the cause of schizophrenia
- Revised dopamine hypothesis attributes excessive presynaptic synthesis of dopamine to positive and disorganized symptoms
- Glutamate hypothesis suggests interactions with dopamine in schizophrenia
- Enlarged ventricles correlated with worse neuropsychological performance and functioning in some with schizophrenia
- Reduction in gray matter and overall volume observed in prefrontal cortex in schizophrenia
- Structural and functional abnormalities in the temporal cortex and reduced hippocampal volume observed in some with schizophrenia
- High stress reactivity found in first-degree relatives of those with schizophrenia
- Loss of dendritic spines and connectivity in brain white matter observed in schizophrenia
- Early environmental influences on neurodevelopment, such as maternal stress and malnutrition, may contribute to schizophrenia
- Cannabis use during adolescence associated with greater schizophrenia risk and symptom severity
- Environmental and sociocultural factors, such as poverty and urbanicity, impact schizophrenia manifestations and outcomes
Test your knowledge of eating disorders with this quiz on their clinical description and epidemiology. Learn about anorexia nervosa, binge eating disorder, and bulimia nervosa, as well as their prevalence, gender ratios, onset age, and associated risks.
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