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Chapter 9: Eating Disorders

• Anorexia nervosa involves restriction of energy intake, resulting in low body weight resulting from an intense fear of gaining weight and a distorted body perception.
• The restricting type of anorexia involves weight loss achieved by cutting out nearly all food, showing little variability in diet.
• Binge eating/purging type of anorexia involves losing weight by purging or binge eating.
• Anorexia progression tends to begin with someone who is average to slightly overweight and goes on a diet.
• Anorexia may escalate after a stressful event, occurring in about 0.6 to 4% of women.
• Most individuals with anorexia recover, but about 6% will die from the disorder or suicide.
• The key goal in anorexia is to be thin, with the driving motivation being fear and preoccupation with food.
• Psychological concerns associated with anorexia include depression, anxiety, sleep disturbance, OCD, and substance use.
• Medical problems from anorexia include amenorrhea (no period), low body temp, low BP, low bone density, slow HR, metabolic and electrolyte imbalance, and skin, nail, and hair problems.
• Bulimia Nervosa includes recurrent episodes of binge eating, that involves eating large amount in short time and lack of control over eating during episode
• Bulimia also involves recurrent compensatory behavior to prevent weight gain, that involves vomiting, laxatives, diuretics, fasting, or excessive exercise, and occurs on average at least 1 time a week for 3 months
• Binge episodes are episodes of uncontrollable eating, typically ranging from 1-30 episodes a week, usually in secret.
• Binges are usually preceded by feelings of tension and followed with guilt/shame.
• Purging also known as compensatory behavior, may provide temporary relief.
• Progression of bulimia nervosa usually begins in adolescence and is most common in normal or slightly overweight females, affecting about 1-1.5% of females.
• Binge Eating Disorder does not involve purging and occurs in 2-7% of the population, with about 64% being women.
• Half of people with binge eating disorder will become overweight and shares many features of BN and AN without the drive to be thin.

Similarities and Differences of Bulimia and Anorexia

• Both typically begin after dieting.
• Both include a fear of weight gain/obesity and preoccupation with food.
• Both share anxiety, depression, perfectionism, and an increased suicide risk.
• Bulimia has more concerns with pleasing others and includes mood swings, boredom, and impulsivity.
• Significant weight differences exist between the two.
• Anorexia is marked by amenorrhea and dental problems.

Causes of Eating Disorders

• Most theorists use a multidimensional risk perspective, where more factors increase the likelihood of developing an eating disorder.
• Hilde Bruch's psychodynamic theory suggests disturbed mother-child interactions lead to serious ego deficiencies, causing children of ineffective parents to become confused adults.
• Individuals with eating disorders inaccurately perceive internal cues and worry how they're viewed, according to the Hilde Bruch theory.
• The cognitive-behavioral view, based on Bruch's explanation, suggests individuals improperly label internal sensations and needs.
• Sufferers have little control in life so they excessively control of body size
• Other causes of Abnormal brain circuit
• Possible biological factors may include brain circuit abnormalities, some genes can increase risk and relatives of those with eating disorders are 6x more likely to also develop
• Dysfunction of the brain circuit may be linked to problems with interconnectivity as well as abnormal activity levels of serotonin, dopamine, & glutamate and some focus on hypothalamus.
• Multicultural factors indicate young African American women tend to show healthier eating patterns, while Hispanic female attitudes are similar to white females.
• An increase of eating disorders has been seen in Asian American women.
• Males account for 10% of all cases and use different weight loss methods and reverse anorexia nervosa or muscle dysmorphia in men.

Treatments

• Anorexia nervosa treatment involves restoring weight and good eating through nutritional rehabilitation, IV feedings, a combination of nursing care, nutritional counseling, and high calorie diet, as well as motivational interviewing.
• Bulimia nervosa treatment sees 43% will receive treatment, usually in an eating disorder clinic, through diaries/apps, exposure and response prevention, and antidepressants.
• Binge eating treatment is similar to bulimia, with about 44% receiving treatment through therapy and antidepressants, but it has a high relapse risk and needs additional weight management interventions.
• Pica involves persistent eating of nonnutritive, nonfood substances for at least 1 month unrelated to cultural norms.
• Rumination Disorder involves repeated regurgitation of food which may be re-chewed, re-swallowed, or spit out and is not attributed to a medical condition and does not occur exclusively due to another eating disorder.
• Prevention of eating disorders includes a "Body project" involving 4 weekly group sessions with high school and college age women, and it showed decrease in women who developed eating disorders, and provides more realistic and healthy views,

Chapter 11: Sexual Disorders & Variations

• Sexual dysfunctions involve a persistent inability to function normally in the sexual response cycle, affecting 30% of men and 45% of women.
• The normal sexual response cycle includes desire, excitement, orgasm, and resolution, and dysfunction will impact stages 1-3, with little to no resolution if other stages dont happen.
• Disorders of desire include a lack of interest or urge to have sex, fantasies, or attraction, and can manifest as male hypoactive sexual desire disorder or female interest/arousal disorder.
• Male hypoactive sexual desire disorder involves a recurrent reduction in sexual thoughts and activity for at least 6 months not better explained by something else.
• Female sexual interest/arousal disorder involves a reduction in sexual interest/arousal with at least 3 of the following: reduced interest in sex, sexual thoughts or fantasies, initiation of sexual activity and unreceptive to partner's attempts to initiate.
• Female sexual interest/arousal disorder also includes, sexual excitement and pleasure during sexual activity, sexual interest and arousal to any sexual cues, sensations during sexual activity, lasting for at least 6 months causing significant distress not better explained by another psychological disorder, relationship distress, or stress.
• Biological low sexual desires can be caused by abnormal hormone levels (high prolactin, low testosterone, high or low estrogen), medications, drugs and long term illness
• Disorders of excitement related to : Excitement phase (2) is marked by change in pelvic region, increase in heart rate, muscle tension, blood pressure, and breathing
• Dysfunctions that affect this phase can be Female sexual interest/arousal disorder or Erectile disorder
• Erectile disorder can be caused by: Biological causes, Hormone imbalances, Vascular problems, Nervous system damage, psychological causes(Severe depression/ Performance anxiety and spectator role), or Sociocultural causes (Job loss and/or financial stress/Marital stress)
• Disorders of Orgasm: Orgasm phase is peak pleasure and tension being released as pelvic muscles contract leading to Dysfunction of orgasm.
• Dysfunctions of orgasm can be Premature ejaculation, Delayed ejaculation or Female orgasmic disorder
• Premature ejaculation features a recurrent pattern of ejaculation within 1 minute, occurring for at least 6 months on almost all occasions of sex and is not better explained
• About 30% of men will have it happen as some point due to Biological theories such as Genetic predisposition, Overactive and underactive serotonin or Greater penis sensitivity
• Causes of delayed ejaculation: 10% of men worldwide will have this, if less than 1% will complain for longer than 6 months
• Delayed ejaculation is Impacted by low testosterone, neurological disorders, head/spinal injuries.
• Delayed ejaculation is caused by Psychological theories through Performance anxiety, Masturbation habits or Hypoactive sexual desire disorder
• Female Orgasmic disorder consists of Either delay/absence of orgasm OR reduced intensity of orgasms being present nearly all occasions of sex and lasts 6 months and is not better explained
• Causes of Female Orgasmic disorder: 21% of women will experience due to Biological causes(Diabetes, MS, neurological diseases, Drugs and medicine, Menopausal changes)
• Female Orgasmic can also be caused by Psychological causes (Depression/ Childhood trauma and relationships) or Sociocultural causes(Society's sexual restrictive role/ Ist experience Disorders of sexual pain are More common in women/ caused by Vaginismus: Involuntary contractions of outer third of vagina, Learned fear,Infection, disease, menopause
• Dyspareunia: is Severe pain in genitals during sex
• Genito-Pelvic pain/penetration disorder: Recurrent difficulties in 1+ of the following (Vaginal penetration/ Vulvovaginal or pelvic pain/ fear/anxiety about pain/ Tensing of pelvic floor during penetration) lasting for 6 months or more unless better explained
• Techniques for disorders of desire: Affectual awareness/Self-instruction/Behavior/Insight-oriented exercises/Biological interventions like hormone treatments/Medication
• Techniques for erectile disorder: Focus on lowering performance anxiety and up stimulation/Tease technique/Sildenafil (Viagra)/Injections, suppositories, implants, VED Techniques for premature/delayed ejaculation
• PE ( Behavioral procedure- Stop-start or pause procedure)/ Bio. treatment - SSRIs ( serotonin enhancing antidepressant drugs) DE: Techniques to reduce anxiety and increase stimulation/ Masturbation/ Drugs in increase arousal of sympathetic nervous system
• Techniques for female orgasmic disorder: Focus on women who have NEVER had an orgasm/ Self exploration/ body awareness enhancement/ Directed masturbation training/ Viagra
• Techniques for Genito-pelvic pain/penetration disorder: Specific treatment for involuntary contraction of vaginal muscles typically involves 2 approaches (Practice tightening and releasing vaginal muscles to gain control/Overcome fear by gradual exposure treatment)/ Botox

Paraphilic Disorders

• Any intense and persistent sexual interest other than interest in genital stimulation or fondling with normal, mature, and consenting human partners.
• Voyeuristic disorder is recurrent and intense sexual arousal from observing unsuspecting person who is naked or having sex and acted on urges with nonconsenting person and must be at least 18 based on Psychodynamic theory around Feelings of inadequacy or shyness drive search for power and Cognitive behavioral theroy, learned behavior
• Exhibitionistic disorder: 6+ months of recurrent and intense arousal from exposure of one's genitals to unsuspecting person and rarely initiated or desired and is most common in men and before 18
• Exhibitionistic disorder is based on Theories: Immaturity in interpersonal and sexual relationships, fears of masculinity, possessive mother and is treated bu Aversion therapy, masturbatory satiation, insight therapy
• Frotteuristic disorder: 6+ months of arousal from touching or rubbing against non consenting person and Has acted on urges occurs 30% of adult males
• Sexual masochism disorder is intense arousal from being humiliated, beaten, bound, or made to suffer Fantasies, urges, or behaviors cause distress. Often begins in childhood and Develop through classical conditioning
• Sexual Sadism disorder: is arousal from psychological or physical suffering of another person. It also includes: Has acted on urged with nonconsenting person
• Has a tendency to begin in childhood or adolescence, more common in men Pedophilic disorder: Is arousal involving sex with a child
• Can emerge during adolescence with half of the victims being girls, Sexually abused as child
• Treatment include : immaturity/ distorted thinking or imprisonment if forced in treatment
• Fetishtical Disorder: Arousal from the use of nonliving objects or focus on nongenital body part
• Treatment: Not limited to articles of clothing used in cross dressing or sexual devices
• Very common for men w psychodynamic theory - defense mechanism to avoid sexual contact anxiety

Chapter 12: Schizophrenia & related disorders

• Schizophrenia spectrum involves psychosis, a state of loss of contact with reality, which can occur from substance abuse, brain injury, or another disorder.
• Schizophrenia involves functioning deteriorates due to unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.
• In schizophrenia, two or more of the following symptoms must be present: delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms, lasting 6+ months.
• Schizophrenia symptoms can be positive (inappropriate behaviors present) or negative (appropriate behaviors absent).
• Positive schizophrenic symptoms include an excess of bizarre additions to thoughts, emotions, or behaviors.
• Negative schizophrenic symptoms include deficits in normal thought, emotions, or behaviors.
• Disorganized thinking/speech may manifest as loose associations or derailment (rapidly shifting from one topic to another), neologisms (made up words), perseveration (repeating the same things over and over), or clang (rhymes).

Negative Schizophrenia Symptoms

• Poverty of speech which is a Reduction of quantity in speech or content while some may speak a lot but have little meaning
• Restricted affect where the is little emotion and expressionless face, or Blunt
• Loss of volition where the is A feeling drained of energy/interest in normal goals
• Social withdrawal or the Inability to have social skills
• Delusional Disorder causes 1+ delusions lasting 1 month or more, Criterion A for schizophrenia has never been met, Functioning is not impaired and behavior is not considered odd , If mania has occurred, it was brief when compared to delusions and could be attributed to substance use or another condition
• Certain neurons in the neurons using dopamine are firing too often messages traveling from dopamine: sending neurons to dopamine receptors may be transmitted too easily/too often are causing Based of the Biochemical abnormalities
• Structures in the Prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra that function and interconnect in problematic ways
• Transmission of Viruses occur before birth will trigger's a passed-on immune response and Interrupts fetal brain development: animal models & studies on births in the late winter and mother being exposed to the flu

Psychological and Sociocultural Views

• Psychodynamic explanation- Schizophrenogenic mothers- mothers who are cod, uninterested and little research support
• Cognitive-behavioral Explanations - operant conditioning Some are not rewarded in childhood and Focus on irrelevant cues and responses that become odd and may lead to Misinterpreting unusual sensations
• Multicultural factors- African americans are more likely than whites to receive diagnosis
• Social labeling: self-Fulfilling Prophecy and Rosenhan study
• Family dysfunction can be Linked to family stress and High expressed emotion tied to relapse where Those with schizophrenia can be hard to live with

Past and Present Treatment

• 1793: move form asylums toward large mental hospitals - Moral treatment (sympathy and kindness)/ Public mental hospitals (state hospitals) for patients who couldn't afford private care
• 1955: Overcrowding and understaffing created dramatic changes. Shift to earlier treatment using restraints, isolation, and punishment - Straightjackets and handcuffs and common pattern of decline was social breakdown syndrome
• 1950's had two Institutional Approaches: Milieu therapy: a therapeutic environment with a good community and Systematic use of operant conditioning techniques (Patients are being rewarded, reduces psychotic/related behaviors)
• Antipsychotic Drigs and Antihistamines (phenotiazines: calms patients about to have surgey)- Chlorpromazine tested on patients with psychosis to help to reduce sharp symptoms
• Approved in the US in 1954

Chapter 13 - Personality Disorders

• Paranoid personality disorder: marked by persistent distrust and suspicion of others, not occur exclusively during another psychological disorder or due to a medical condition, belief that others are are exploiting/ deceiving or harming them, preoccupation of doubted loyalty, grudges and reacts angrily
• linked to psychodynamic theory, early demanding parents and maladaptive assumptions during cognitive behavior

Personality Disorder Types

• Schizotypal Personality Disorder: Pattern of social deficits that cause discomfort and relationship w eccentric behaviors
• Tend to think with ODD beliefs or magical thinking and become very paranoid and social Anxious
• These symptom are often linked to family conflicts where parents have psych disorders/linked to mood disorders.
• Help client to know thinking limits to recognize unusual thoughts, speech/dress lesson, behavior therapy to world.
• Schiroid Personality Disoder: Pattern of detachment from relationships and restricted emotions,doesn't close relationship and is uninterested to outside praise/criticism
• Insecure need of contact where rooted in unsatisfying abusive parents/ deficiency in thinking by yo yo pick you up

Cluster B: "Dramatic" Personality Disorders

• "Dramatic" personality disorders can have a hard time establishing and maintaining relationships due to dramatic and emotional nature.
• Causes for personality type are not well understood and can be well effective
• Antisocial Personality Disorder shows disregard for rights of others, failure to mold to social norms, deceitfulness and may lack Remorse and displays symptoms before age 15
• Anti-social Personality: can have an absence of parental love leads to lack of trust; antisocialness learned through operan

Antisocial + Mental Health Disoders

• Cognitive - difficulty recognizing others' feelings
• Education to help change disorders by low seratonin levels
• Borderline personality disorder: unstable. Relationship , self-image, affect, abandonment, and is hard to manage and control anger
• Unstable relationships can have rapid socioculture and lack of serotonin, hard time on dealing with inner/ outer force/ can't control their parents
• Treatment: Relational Psychoanalysis behavior(DBT). Behavior (mood stabilizer) Histrionic personality behavior Shows Excessive Emotionality & attention seeking, but becomes Uncomfy
• Narcissistic personality disorder - Grandiosity, need to control empathy: when cognitive is treated super positive to where you over Value self
• "Cluster C" "Anxious"Personality Disorders :Anxious fear Theory:

Clusted C: "Anxious"

• Avoidant personailtiy - social unhbitation feeling inadequacy , sensitive to negative and have no risk taking
• Therapy is the easiest and gains patient's therapy anxiety with phobia but resolve unconscious conflict to have a positive self-image Need to be taken care or: submission cling: hard on expression or feeling alone
• Freudian:Overinvolvement OR overprotection

Personality Disorders - Pt 2

Treatment(psychodynamic): transfer agency Biological- anti depress drug

• OCL: Orderlines, over perfectiousn and Control: believe is wrong is - often respond to dynamic or cognitive
• Big5s: Openess/Concieniouness/Extroversion/Agreeablness/ Neuroticism
• Bullying is often a major concern to almost 20% of students is bully very frequently.
• Some disorders of children -ADULTS - others disappear by adulthood Selective Mutism Failure to speak despite in other situations Interferes andNOT due to comfort major depress disorder.
• can turn in negative life of being in disinterest

Conduct Disorder Types

• Overt destruction: overtly and confrontational
• Covert destruction: secretive, destruction behavior
• relational-social misdeeds factor- trauma related Treatment Most effective of 13
• parent Multi systems grade develop skills training

Disorders

• Enuresis Wetting beds-2+ weaks

• due to substance use or medical condition

• no theory to support case

• resolve is its own

• CB Therpay: Speed us the proccess

• Passage Of feces in inappropriate places

• Adhd Hypeacitivity - Autism- intellectual

ADHD causes

• Biol -Dopamine in attention circuit Family dysfunction, multicultural factors
• Hisonic/black less in whites to get the dx or Treatment Autisms appear before age 3- 80% in boys that happen to have language problems
• echols, Pronomial Treatment - teaching New Behaviors opernantal Early behaviors - is preferred- and community
• intekkectal/Disabiliy -
• tradiaotnall 4 levels iq 50-70 midrate35-39 servery 20-34
• prfolund below 1wo that fall here link social cultures with poo/child relationship deficnsy with language develop with poor motor skills
• Cromosnall calies

Mental Health Disorders

• Dwon synderome;Abnrornlaittes
• Fragilex- X chormose
• metaboic- body broken of production or chemcal
• efectice gene pkru
• parental or birth relted
• low loidne irtalnic alcohol alnfection long perioed
• ancto - x rays incertu- maninmtes - enfacilltis - can lead ti treatment.