Psychopathology: Definitions and Eating Disorders

Key Definitions

• DSM-5TR Definition: involves individual difficulties in cognition, emotion, and behavior, causing personal distress and dysfunction, while not being a culturally specific reaction or socially deviant behavior.
• Prognosis: the likely course of a disease or ailment.
• Epidemiology: the study of the distribution and determinants of health-related states or events in specified populations.
• Etiology: the cause, set of causes, or manner of causation of a disease or condition.

Eating Disorders

• BMI is used as an assessment of body image, measuring weight against height.
• Distorted eating can be assessed by comparing current, attractive, and ideal body types, with a greater distance indicating distortion.
• Relatively healthy eating habits are present when current and attractive body type perceptions are similar to the ideal.
• Developmental trends in body satisfaction show body size and weight are unrelated to body appraisal in preschool, while BMI and body dissatisfaction start to correlate in middle childhood (5-9 years old).
• During adolescence and young adulthood, body esteem decreases, especially in girls, and weight gain during sexual maturation correlates with body dissatisfaction.
• In adulthood, body dissatisfaction remains but with lower correlation, self-esteem becomes less related to body image despite weight gain in middle age, and weight perception/dieting decreases, even with increased weight due to marriage and parenthood.

Feeding & Eating Disorders

• Anorexia Nervosa: Involves obsession with food restriction
• Bulimia Nervosa: Characterized by recurrent episodes of binge eating with compensatory behaviors.
• Binge eating disorder: Consists of recurrent episodes of binge eating without compensatory behaviors
• Common features of eating disorders: obsession with food and weight, disordered eating, and preoccupation or distortion in body image.
• Other eating disorders include Pica, Rumination eating disorder (regurgitating food), and avoidant/restrictive food intake.
• Comorbidity/Similar disorders: MDD (changes in appetite), OCD (obsessions and compulsions), and BDD (obsession with body).

Anorexia Nervosa

• Involves an obsession with food, not a loss of appetite.
• DSM-5TR Criteria include: Refusal to maintain normal weight for age, intense fear of gaining weight, and disturbance of body perception.
• Amenorrhea has been removed as a criterion from DSM-V.
• Individuals may shift between subtypes of anorexia.
• No duration requirement, BMI takes time to return to normal
• DSM-5 Subtypes:
  • Restricting type: Limits caloric intake through fasting, dieting, and excessive exercise.
  • Binge-eating/purging type: Periodically engages in cycles of binging and purging (~50% prevalence).
• Symptoms include restriction of behaviors promoting a healthy body weight, a strong fear of weight gain, and distorted body image.
• Features of Anorexia Nervosa:
  • Lifetime prevalence ~2%
  • Majority: White, upper-middle class
  • Age: 15-19
  • Chronically underweight
  • High comorbidity with anxiety, OCD, depression, and SUD
  • Chronic and resistant to treatment (compared to bulimia).
• Psychological Features:
  • Perfectionism (even after weight restoration).
  • Emotionally reserved, intolerant of negative emotions.
  • Likes routine and predictable environments.
  • Heightened conformity, avoiding risk-taking, and experiencing high stress-related distress, possibly coupled with high neuroticism.
• Medical Consequences:
  • Amenorrhea (absence of 3 consecutive menstrual cycles).
  • Osteoporosis from malnutrition.
  • Dry skin, brittle hair, and nails.
  • Sensitivity to cold and lanugo (fine hair growth).
  • Heart problems, fainting, fatigue, electrolyte imbalance, and kidney damage

Anorexia Nervosa in Men

• Rising diagnosis rates; characterized by pursuit for build.
• Atypical eating disorder as it does not always meet diagnostic criteria
• Mortality: AN has a high mortality rate (5-8%) due to medical complications and suicide. Suicide rates: 5% complete, 20% attempt, and 1 in 5 die of suicide.
• Prognosis: 50-70% recover within 6-7 years, but relapse is common. and is hard to modify cognitive distortion, especially in cultures that value thinness.
• Death rate is 10x higher than the general population and Death rates are 2x other psychological disorders

Bulimia Nervosa

• Involves the bous "ox" and limos "hunger", defined as “ravenous hunger”.
• DSM-5TR Criteria:
  • Recurrent episodes of eating a large amount of food in a discrete period with a lack of control.
  • Recurrent compensatory behavior to prevent weight gain, such as vomiting, using laxatives/diuretics/enemas, fasting, or excessive exercise.
  • Binge eating and compensatory behavior occur at least once a week for 3 months and Self-evaluation is unduly influenced by body shape/weight.
• Process:
  • Usually follows a failed diet and is tied to self-esteem.
  • Associated with low self-esteem and high negative affect.
• dieting as a way to feel better, but the Diet is too restrictive, which causes a break from the diet and a Binge Negative emotions exacerbate, leading to compensatory behaviors to reduce fears of weight gain
• Features of BN:
  • Lifetime prevalence of 0.5-2%.
  • Age of onset: 15-29 (later than AN)
  • 90% of cases are women.
  • Individuals tend to be in a normal weight range.
  • High comorbidity with anxiety, depression, substance use, and trauma, involving hiding binge episodes.
• Medical Consequences:
  • rashes/calluses on the back of the hand ,tooth decay/throat injury, intestinal injuries, and heart problems.
• Psychological Consequences:
  • shame and guilt, shame of being discovered, and being triggered by social comments/social stress.
• Prognosis:
  • 75% recover, 10-20% remain fully symptomatic.
  • Early intervention improves outcomes, with poorer prognosis for those with depression, SUD, or severe symptoms.

Binge Eating

• DSM-5TR Criteria:
  • Recurrent episodes, with a discrete period of time of eating a lot of food.
  • Lack of control during the episode.
• Episodes are associated with eating faster than normal, eating until uncomfortably full, eating large amounts of food when not physically hungry, eating alone due to embarrassment, and feeling disgusted, depressed, or guilty afterward.
• There is marked distress regarding the binge (negative emotionality), and the binge eating occurs once a week for at least 3 months.

Associated Features of Binge eating disorder (BED)

• BED has a lifetime prevalence of 1-5%
• higher/middle income countries BED > BN
• Obesity BMI > 30
• More psychopathology v.s. Non-binging obese people
• Very concerned about body shape/weight
• Risk factors: Childhood obesity, low self concept, depression, bullied about weight, Childhood physical/sexual abuse
• chronic and persistent, Evoke dissociative state, Separate from feelings
• Slightly women > men (smaller gender diff than AN or BN)
• Later age onset than AN/BN
• Relationship with dissociation Consequences: Weight gain/obesity -> Note that not all obese people qualify for BED

Binge Eating - Associated w/ Obesity

• Type II Diabetes
• Cardiovascular disease
• Breathing problems
• Physical (joint/muscle pains)
• Not associated w/ obesity
• Sleep problems
• Anxiety/depression
• Irritable Bowel Syndrome (IBS)
• Prognosis: Between 25-82% recover (need more research)
• Takes longest for indiv. w/ BED to get help
• Multimodal treatment (mental health + physical)
• Subclinical symptoms: Symptoms that don't quite reach a diagnosis
• Eating disorders/psychopathology as continuous, not categorical
• Some statistics: 38% normal weight college women believe they are overweight, 30% college women say they never diet, 15% college women engaged in purging behaviors, 28% college women reported being obsessed with weight

ED Comorbidity

• BN has high comorbidity with many disorders
• Comorbidity with SUD increases mortality in males with AN
• ED & Gender: 10% with ED are men.
• Body image concerns affect both genders, with males usually growing up with negative reactions from peers.
• AN males tend to be dependent/avoidant and fail to conform to cultural expectations for masculinity, while BN risk factor is homosexuality/bisexuality.
• Sociocultural pressures lead to the internalization of lean/muscular ideal.

Eating disorder Etiology: Genes and Environment

• Risk factors: Female sex and family history (GxE), genetic vulnerability
• High Expressed Emotion (EE). Enmeshment, no boundaries (AN risk factor), abandonment
• Participation in activities dance, sports (not BN): Psychiatric comorbidity
• Biological Etiology: Biochemical: low serotonin – feeling of fullness (possibly also connected w/ MDD)
• Etiology: Social Factors
• Beauty standards: Thinness, Media exposure
• Study on Fijian adolescent girls w/out media exposure
• Impact of media exposure: Disordered eating correlated w/ exposure to Western media

Historical trends

• analyzed women's magazines, Weight going down, Diet & exercise going up
• Social Media Exposure: Meta-analysis of experimental studies
• A systematic review (Dane & Bhatia, 2023):
• Social comparison, thin/ideal internalization, self-objectification
• Poor body image concerns, disordered eating/ED Family Influences: Successful, driven, pressured

Treatment for Anorexia

• Cognitive bias to attend to physical markers in self/others
• Dichotomous thinking: all or none mindset
• Resistant to treatment: hospitalization sometimes required

Eating Disorders: Comparison

• BMI and weight don't suffice for diagnoses, BEHAVIOR is more important
• Differential Diagnoses: Binge/Purging AN vs. BN: Gross distortion of body image in AN, Pervasive body dissatisfaction in BN, AN has high mortality anorexia nervosa vs other disorders

Childhood Disorders: Developmental Psychopathology

• behavior and different developmental perspective/age means different things
• NOTES
• combining clinical and developmental is important
• first understand normal development: development is cumulative

Disruptive, Impulse-Control, Conduct Disorders:

• Neurodevelopmental disorders: ODD (externalizing), CD (externalizing), ADHD (externalizing), ASD (internalizing?)
• Diagnosed: 3-7 years old
• Not physical violence
• Hostile towards authority

4 symptoms for >6 months Symptoms: Angry Irritable Mood, Argumentative/Defiant Behavior, Vindictiveness

• conduct disorder (CD) Notes - repetitive/persistent behavior - can be physical violence - violates

3 symptoms in past 12 months, >1 symptoms in past 6 months Symptoms - Aggression to people and animals - Destruction of property - Deceitfulness/theft - Violation of rules

Epidemiology/Notes re calloueness

• Epidemiology: ODD – diagnosed age 3-7, Dx later if CD criteria not met, CD - diagnosed in adolescence
• Callous: insensitive to punishment, hypoactivity of amygdala is a factor: may be antisocial
• ODD and CD, what they have in common:
  • OOD & ODD and CD: prevalence is 8-12% combined,
• Development - 1 in 4 boys with ODD → CD, lots of linkage but not the same
• Behavior -
  • behavior can go from overt to covert with age, aggression, Gender ###The Age Crime Curve
• The age crime curve shows Adolescence is peak of arrest
• Development of Conduct Problems
• Moffit (1993): the life course persistent
• Onset after age 10: Maturity Gap Biological Etiology
• Deficits in executive functioning plan and control are Frontal lobe abnormalities Behavior from overt to covert w/ age:

Neurodevelopmental Disorders - Autism

• Characteristics:
  • manifests early in development
  • behaviors dont meet development milestones
  • characterised by: intellectual ability, communication disorders 1

Attention Deficit Hyperactivity Disorder (ADHD)

• Predominantly Inattentive (least common)
• Predominantly Hyperactive-Impulsive
• Combined (most common) Duration: 17 years or lower: > 6 symptoms > 6 months

Neurodevelopmental Disorders - Autism Spectrum Disorder (ASD)

DSM-5TR Criteria: A. Social communication & interaction Autism Spectrum Disorder (ASD): Deficits in developing, maintaining, understanding relationships:

Biogenetic Explanations of Mental Disorder The Mixed-Blessings Model, according to

Haslam and Kvaale: Biogenetic Explanations and Stigma attribution of uncontrollability can lower stigma. ##The model: The relationship between blame and social/psychological stigma is complex - mixed The Mixed-Blessings Model of Mental Disorder and Stigma: Essentialism can lead to prejudice, inherently pathological, uncontrollable, “the other”

• Patients can still have agency and optimism