Psych Final PDF

Q: In what ways does culture affect how we view psychological problems? Psychopathology & Culture Ex: What is Otaku? https://www.youtube.com/watch?v=u5g D-v0Xsrc (4.5 minute video) Otaku “Nerd Nation: Otaku and Youth Subcultures” Some questio...

Q: In what ways does culture affect how we view psychological problems? Psychopathology & Culture Ex: What is Otaku? https://www.youtube.com/watch?v=u5g D-v0Xsrc (4.5 minute video) Otaku “Nerd Nation: Otaku and Youth Subcultures” Some questions: What qualities characterize otaku? Is it abnormal? Why do some think it is problematic? What are reasons why we might not view it as problematic? Is it psychopathology, i.e., a psychological disorder? Is it a disease/ medical problem? Culture-Bound Disorders What are some examples of culture-bound disorders? What is your reaction to various disorders from other cultures? Examples of Culture-Bound Disorders Hikikomori (Japan) Dhat syndrome (South Asia) Eating disorders (Western) Koro (Southern China, etc.) Ataque de nervios (Puerto Rico) Amok (Malaysia & SE Asia) Hysteria (mid 1800’s Europe) Frigophobia (China) Susto (Latin America) Voodoo death (Africa) Latah (SE Asia, Siberia) Malgri (Australia) Some Examples of Universal Psychological Problems Depression Social anxiety disorder e.g., TKS: taijin kyoufushou in Japan Schizophrenia Suicide Semester Wrap-Up Some broad issues that we have explored: What is “abnormal”, psychologically? Different theoretical approaches to psychopathology Understanding research in psychopathology Understanding how psychological diagnosis works; categories vs. continuums Understanding the person, and not just the disorder Understanding that causal factors mutually influence each other Topics over the semester Anxiety disorders Obsessive-compulsive disorder Stress, trauma, & post-traumatic stress disorder Dissociative disorders Mood disorders Eating disorders Personality disorders ADHD Autism Schizophrenia Culture As we move to a more integrated approach, what is wrong with this graphic? Biology Feelings Thoughts An integrative, multidimensional approach Thoughts Feelings Biology Environment Behavior Your Integrative Paper What is something interesting that you learned or thought about through reading, researching, and writing your paper? Treatments of Schizophrenia Discarded approaches to treating schizophrenia In the past have tried: Lobotomy Insulin coma therapy Electroconvulsive therapy (ECT) “Warehousing” in psychiatric hospitals Q1: What should be targeted as part of treatment of schizophrenia? What needs to be changed/ improved? Q2: How could each of those aspects be addressed? What type(s) of treatments/ approaches work? So how should we approach the treatment of schizophrenia? 1) Reduce psychotic symptoms (the positive symptoms): 1950’s: Antipsychotic medications introduced (also called neuroleptics): The first anti-psychotic meds were the phenothiazines, of which chlorpromazine (Thorazine) was best known. Other phenothiazines: Stelazine, Mellaril, Prolixin. Other later antipsychotics: Haldol, Navane. Second-generation antipsychotics: Clozaril, Risperdal, Zyprexa. Reduce positive (& negative) symptoms. Reducing psychotic symptoms, cont. But phenothiazines have side effects, esp. tardive dyskinesia See Meet Jeff, Living with Tardive Dyskinesia https://www.youtube.com/watch?v=wMjuM8_vt6I (watch 0:43 – 6:01). Cognitive-behavioral therapy: has been shown to reduce both positive and negative symptoms Additional Considerations in Treatment of Schizophrenia "Even after a) psychosis has resolved, the b) negative symptoms make it difficult to reestablish a sense of interpersonal connectedness, and c) neurocognitive deficits and other lingering problems make it difficult to resume community functioning." At this time treatment for overcoming each of these hurdles is spotty. How to approach the treatment of schizophrenia, continued 1) Reduce psychotic symptoms (the positive symptoms): antipsychotic medications, cog-beh therapy. 2) Reduce negative symptoms: the newer generation of antipsychotic drugs may help; cog-beh therapy 3) Improve neurocognitive deficits: medications, or cognitive remediation, also called neurocognitive rehabilitation -- may help 4) Reduce disability, help cope with having the d/o, & improve functional outcome: e.g., social skills training, occupational training, social services, family therapy; assertive community treatment. Reducing Disability & Improving Functioning: Psychological/ Social Treatments Coping with stress and conflict Encourage continued use of medication Cognitive: recognize and change attitudes toward schizophrenia Behavioral: operant conditioning, e.g., token economy; also modeling to teach skills, e.g., social skills training Support groups Family therapy Assertive community treatment programs (community mental health inc halfway houses, group homes: “The Lodge”) Schizophrenia(s) Understanding schizophrenia Understanding schizophrenia(s): Does acute vs. chronic matter? Carpenter (2012): ◦ Is psychotic experience (sometimes) a meaningful response to the conditions of one’s life? a “spiritual emergency” requiring “new self-construction”? ◦ Acute psychotic break vs. Chronic psychosis ◦ Evidence that brain-altering anti-psychotic medications have short-term positive effects, but do they have long- term negative effects? ◦ “A brain that never truly had a ‘chemical imbalance’ now has one for sure, caused by drug withdrawal.” Eleanor Longden: The Voices in My Head (14 min) https://www.youtube.com/watch?v=syjEN3peCJw Clues to Biological Causes of Schizophrenia Q: When does schizophrenia start? Schiz. Causal Factors: 1. Genetics ◦ Offspring of two parents w schizophrenia = 46% ◦ Epigenetics: env’tal conditions affect gene expression Schizophrenia Causal Factors: 2. Abnormal Brain Structures ◦ Enlarged brain ventricles (perhaps particularly associated with negative symptoms) ◦ Abnormalities in prefrontal cortex (smaller, low activity) ◦ Variety of other areas: hippocampus, limbic system, basal ganglia, reductions in white matter (connections, memory)… Schizophrenia Causal Factors: 3. Neurotransmitters ◦ Dopamine (details on next slide) ◦ Perhaps other neurotransmitters as well? Evidence regarding neurotransmitters Dopamine (DA) ◦ Phenothiazines (the first anti-psychotics) reduce functional level of DA (they bind to D-2 receptors, preventing DA from binding there, thus reducing the activity level of DA). ◦ Compare with use of L-dopa with Parkinson’s Disease ◦ Amphetamines increase DA function & also increase psychotic symptoms ◦ Brain images show more DA receptors & sometimes more DA in some brain areas of people with schizophrenia. ◦ Regarding dopamine, now we suspect: May be excess DA activity in mesolimbic pathway (cognition & emotion), and this is associated with positive symptoms May be low DA activity in prefrontal area (attention, motivation), and this is associated with negative symptoms. Other possible neurotransmitters: serotonin, glutamate, GABA… Schizophrenia Causal Factors 4. Birth complications: ◦ e.g., 30% of people with schizophrenia experienced perinatal hypoxia. ◦ Prenatal virus exposure: flu virus in 2nd trimester. 5. Mid-March /winter peak in births of people with schizophrenia… Reduced Sunlight Exposure as a Prenatal Causal Factor ? ◦ Mid-March peak in births of people with schiz. ◦ In Brazil, rainfall is an even better predictor of schizophrenia births than is flu season ◦ Bigger spring birth effect in Northern hemisphere, and gets bigger the further north you go (where people live further from equator and get less sunlight in winter) ◦ In Australia, get peak in Spring schizophrenia births in years with El Niño weather system that casts a gloom over Australia ◦ If pregnant rats are deprived of UV light or Vitamin D, their offsprings’ brains have less nerve growth factor and enlarged ventricles! Perhaps prenatal lack of UV light & low levels of Vitamin D increase risk for schizophrenia. Q: When does schizophrenia begin? Is it a developmental neurocognitive disorder? (see Michael F. Green’s book, Schizophrenia Revealed: From Neurons to Social Interactions) Schizophrenia may not centrally be about psychotic symptoms, but instead about 3 key aspects: ◦ 1) disrupted neural connections, specifically reduced neural connectivity, which leads to: ◦ 2) neurocognitive deficits, which lead to misinterpretations and confusions, & eventually to: ◦ 3) functional impairment (e.g., in work, in relationships) Evidence of problems with neurodevelopment in early childhood Home movies: see negative emotions, awkward movements Minor physical anomalies (MPA’s) of head, feet, hands, face Abnormal fingerprints (even when compared to MZ twin!) Increased incidence of ambiguous handedness What normally happens in neurodevelopment in 2nd trimester? Answer: Migration of neurons from inner brain layers to outer brain areas. Q: What happens to neurons during the 2nd trimester in schizophrenia? They stop short of their correct final destination. They end up out of alignment. They fail to make the correct connections. They get excessively pruned. (Excessive pruning of dendrites can cause neurons to squeeze together, to be densely packed.) Some interesting points to consider Why do overt symptoms begin so much later than the neural problems? Schizophrenia appears to be both: ◦ a neurodevelopmental disorder (neural disruptions begin prenatally) and ◦ a progressive disorder: e.g., brain shrinkage occurs after onset of symptoms, & there is a loss of previous social functioning. Neurocognitive deficits are found in schizophrenia (90% show deficits in at least one neurocognitive domain) Perception: backward masking Vigilance/ Sustained attention: e.g., Continuous Performance Test Sensory gating Memory Problem solving/ Executive functions Social cognition: recognition of emotions, theory of mind, understanding social rules Q: Is schizophrenia always associated with neurocognitive deficits? Not always, and not uniformly. In an outpatient study: 90% had at least one; 75% had at least two. Causal factors in schizophrenia: Any psychosocial factors involved? Behavioral: fail to attend to social cues; don’t get reinforced for doing so. Cognitive: cognitive problems + overwhelming information & strange perceptual experiences; also neg automatic thoughts, reasoning biases NOT Family: “schizophrenogenic mother”: overprotective + rejecting (No research support) NOT Double-bind communication: mismatch between content and feeling/ tone/ non-verbals “Expressed emotion” (EE): family is overinvolved + critical. Is associated with increased relapse. Schizophrenia(s) What is the essence of this disorder? Q: Historically, what are the essential elements that have defined schizophrenia? Not clearly described until around 1800. In 1800’s, proposals included: Is it found especially in women? Is it hereditary? Is it “loss of mind?” Called “démence.” Does it have early onset & a quick progression? Called “démence précoce.” What are the key symptoms? Hallucinations & delusions Bizarre behavior Ill for a long time Emil Kraepelin (c. 1896): Dementia praecox What are the key symptoms? Eugen Bleuler (c. 1908): “Schizophrenia” (= splitting of the mind) Disordered thought process: Loosening of Associations Autism Affective disturbance Ambivalence Kurt Schneider (c. 1930): “First-rank” symptoms of schizophrenia Hearing voices Things being done to you by external forces Perceptions that are delusional and hard for. others to understand What are the key symptoms? What are the key symptoms? DSM-5-TR (2013,2022): Need impaired functioning for at least 6 months, & at least 2 (inc one of the first 3) of the following for 1 month: Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Negative symptoms such as: restricted or flat affect, avolition, poverty of speech (alogia), social withdrawal What schizophrenia is like: Video clip https://www.learner.org/series/the-worldof-abnormal-psychology/the-schizophrenias/ (watch from 1:00 to 11:50) World of Abnormal Psychology: The Schizophrenias About 1% of the population will suffer an episode of schizophrenia at some point. Longevity: was comparatively short in the past, so could be a reason why schizophrenia wasn’t observed Age of onset: Males: average onset = 23 Females: average onset = 28 Lower Social Class & Schizophrenia Does low social class breed schizophrenia? (breeder hypothesis) OR Does schizophrenia cause one to drift to lower social classes? (drift hypothesis) One study of men with schizophrenia: Distribution across social classes Social Class Patients (%) Their Fathers % Their Brothers % Census Norms % Higher 4 16 Middle 48 58 Lower 48 27 Distribution across social classes Social Class Patients (%) Their Fathers % Their Brothers % Census Norms % Higher 4 29 21 16 Middle 48 48 56 58 Lower 48 23 23 27 Previous DSM subtypes of schizophrenia Undifferentiated Paranoid Catatonic Disorganized (was called “hebephrenic”) “David,” and some historical perspective: Frontline: Broken Minds https://www.youtube.com/watch?v=Ut0jVLSzWY Can watch David c. 15:13 – 17:45 (when audio cuts out temporarily) & Historical perspectives19:20 - 26:22 & David again 30:56 – 34:20. Neurodevelopmental Disorders: Attention Deficit/ Hyperactivity Disorder (ADHD) Inattention (particularly problems engaging Type 2 attention to override Type 1 attention) Hyperactivity/ Impulsivity (Behavior Disinhibition) ADHD has two clusters of symptoms: Three subtypes of ADHD Combined presentation Predominantly inattentive presentation Predominantly hyperactive-impulsive presentation Associated with ADHD Symptoms must be evident in childhood, before age 12 (used to be before age 7) For 50-60%, symptoms continue into adulthood About 7-10% of children Boys more likely than girls: c. 70% are boys Can be irritable and demanding; May be rejected by other children Some problems associated with ADHD Academic achievement – Score 10 pts lower on IQ tests Learning disabilities or communication problems (c. 50% of those w ADHD) Health problems Sleep problems May develop conduct disorder, or abuse substances, or break the law An alternative look at ADHD: Behavior Disinhibition Disorder (Russell Barkley) Is impulsivity the core, central symptom? Perhaps it is not an input problem, but an output problem, i.e., impulse control issues. The problem is with a particular type of sustained attention: goal-directed persistence. Behavior Disinhibition D/O, cont. Four proposed subtypes: ADD - Inattentive type ADHD - Pure type ADHD - Aggressive type (c. 30% of those with attention deficits) ADHD - Anxious type Causes of ADHD Genetics (siblings 3-4* more likely to have ADHD) Neurological immaturity/ under-functioning of brain circuit: – Prefrontal cortex (cognition, motivation) – Striatum (working memory, planning) – Cerebellum (motor behaviors) – Faulty interconnectivity Dopamine (& maybe norepinephrine) abnormalities Prenatal and birth complications (low birth weight, prematurity, maternal alcohol use…) Environmental toxins (e.g., lead, air pollution) Stress and disruptions in family Is not caused by food intolerance or diet, but hyperactivity might be exacerbated by it Medication Treatments for ADHD Stimulants: e.g., Ritalin (methylphenidate), Adderall, Dexedrine (70-85% have decreased problematic behavior & increased positive mood, interactions, & goal- directedness) Q: Are these medications over-prescribed? Norepinephrine-related meds: reduce tics, increase cognitive performance Buproprion (Wellbutrin): antidepressant, affects dopamine ADHD: Q: Are we being intolerant of childhood playfulness? (Panksepp article) What are the brain functions of play? Additional Treatments for ADHD Cog-Behavioral training programs with parents and teachers: change rewards & punishments – Reinforce attention, goal-directedness, & prosocial behavior – Extinguish impulsive/ hyperactive behaviors – Research shows: reduces ADHD symptoms Parent education: – Operant conditioning; perhaps token economy Educational management in the classroom Autism Spectrum Disorder In DSM-IV, Autism was part of the “Pervasive Developmental Disorders” which included: Autistic Disorder Asperger’s Disorder Rett’s Disorder Childhood Disintegrative Disorder Pervasive Developmental Disorder NOS Autism Spectrum Disorder -- Impairment in Two Domains: Impairment in social interaction & communication Restricted, repetitive, stereotyped patterns of behavior, interests, and activities. Associated with Autism Spectrum Disorder Onset of symptoms is in early childhood. Is a chronic, lifelong condition. More boys than girls (about 80% of those diagnosed with autism are boys) Intellectual Ability & Autism Spectrum Disorder Often (at least 50% of time) it is associated with intellectual disability (in DSM-IV was called “mental retardation”) About 50% never develop useful speech Best predictor of outcome: IQ & amount of language development before age 6 Rarely there are savants But the Autism Spectrum encompasses a wide range of functioning See Temple Grandin: The world needs all kinds of minds (1st 7 minutes or so) https://www.youtube.com/watch?v=fn_9f5x0 f1Q&t=108s Causes of autism spectrum disorder NOT vaccines: no reputable research supports the vaccine-autism link (story of Dr. Andrew Wakefield…) Cognitive: difficulty integrating info from various senses. Deficits in theory of mind. Lovaas: perceptual deficits so that child can process only one stimulus at a time. Genetics: MZ’s: 60-80%; DZ’s= 10% concordance. Prenatal exposure to infection, chemicals, alcohol, drugs. Neurological issues: there is a high rate of birth complications; various indications of irregular brain functioning. Treatments of autism Behavioral therapy, particularly Lovaas’s operant conditioning approach; can include parents Lovaas Videotapes: Tape 1, Part 2 at https://www.youtube.com/watch?v=uX1fz5d2wnw Structured educational services Community integration efforts SSRI’s may reduce repetitive behavior & aggression Neuroleptics (i.e., anti-psychotics) may decrease rocking, self-mutilation, other repetitive behaviors Stimulants can improve attention Asperger’s Disorder – was in DSM-IV, but now is on highfunctioning end of the autism spectrum No impairment in communication or intellectual disability. But do have: Impairment in social interaction Restricted, stereotyped patterns of behavior, interests, activities. Personality Disorders Paranoid Schizoid Schizotypal Histrionic Narcissistic Antisocial Borderline Avoidant Dependent Obsessivecompulsive The Anxious, Fearful Personality Disorders Avoidant Personality Disorder hypersensitivity to criticism & rejection Dependent Personality Disorder submissive and passive Obsessive-Compulsive Personality Disorder rigid perfectionism Avoidant Personality D/O (hypersensitivity to criticism & rejection) Fears criticism and rejection Wants to be in close relationships, but fearful Deeply conflicted re. intimate relationships May seem aloof, like a loner, socially isolated Waits for others to seek them out; unassertive Avoidant p.d. = afraid of relationships compare to: Social anxiety disorder = afraid of social situations. Dependent Personality D/O (submissive and passive) Attaches self to a strong other person Dependent on other(s) for happiness, welfare Seek lots of advice & reassurance for decisions Feel helpless when alone Devastated if relationship ends Fear being abandoned May subordinate self to keep relationship Obsessive-Compulsive Personality D/O (rigid perfectionism) Wants to control things Excessively organized and scheduled Inflexible, strict, stiff, not tolerant of others; perfectionistic May seem judgmental of self & others Preoccupied with details, rules Not warm; may seem stingy Diagnostic criteria do NOT include obsessions OR compulsions! Sheldon Cooper, The Big Bang Theory Passive-aggressive personality disorder?? (is not in the DSM since DSM-IV) DSM-5-TR Alternative Model; Personality Disorder – Trait Specified Q1: Is there disturbance in sense of self (identity & self-direction) and interpersonal relationships (capacity for empathy & intimacy?) Q2: Are there any pathological traits? – Negative affectivity (high N) – Detachment (tend to withdraw; like low E) – Antagonism (at odds w other people; low A) – Disinhibition (impulsivity; low C) – Psychoticism (odd thinking, bizarre experiences) Q3: Do they meet criteria for any of 6 specific p.d.’s? (specified on next slide) Alternative Model, cont.: The Six Personality Disorders Specified Schizotypal p.d. Antisocial p.d. Borderline p.d. Avoidant p.d. Obsessive-compulsive p.d. Narcissistic p.d. (by popular demand!) Case Conference: Amanda (see handout for questions) Personality Disorders Paranoid Schizoid Schizotypal Histrionic Narcissistic Antisocial Borderline Avoidant Dependent Obsessivecompulsive The Dramatic, Erratic, Emotional Personality Disorders Histrionic Personality Disorder excessive emotionality Narcissistic Personality Disorder grandiose self-importance Antisocial Personality Disorder disregard for social rules Borderline Personality Disorder instability of identity Narcissistic Personality Disorder (grandiose self-importance) Exaggerates accomplishments, boasts; is arrogant Sees self as superior to others Feelings of entitlement Self-importance may alternate with unworthiness Hypersensitive to criticism, seeks compliments Exploitative of others, not empathetic Seeks constant attention Preoccupied with fantasies of fame, wealth, power, appearance Narcissistic Personality Inventory measures 4 aspects of narcissism: leadership/ authority self-absorption/ self-admiration superiority/ arrogance exploitiveness/ entitlement Video clip: Meeting Gilderoy Lockhart (from Harry Potter) https://www.youtube.com/watch?v=6gxYEcN PkQo Gilderoy Lockhart from Harry Potter Q: Does our society promote & reward narcissism? For example, does the character of Mark Zuckerberg in “The Social Network” exhibit narcissistic p.d.? (note: we’re analyzing the character depicted in the film, & not necessarily the real Mark Zuckerberg) Film clips with analysis of The Social Network: Narcissistic Personality Disorder: A Portrait https://www.youtube.com/watch?v=PuB_ng5uVaI (start at about 1:45, go to about 11:50) Narcissistic Personality D/O in Our Society Antisocial Personality Disorder (disregard for social rules) Disregard for social rules/law, irresponsible Violate others’ basic rights & social norms Little or no remorse Impairment in forming positive relationships Focus on gratifying own desires Takes advantage of others (lies, deceives, cons others) Poor impulse control; perhaps thrill-seeking Seem to not have well-developed conscience May be aggressive/ criminal/ violent, but not necessarily Antisocial Personality D/O, cont. “Psychopath” or “Sociopath” refers to a subset of antisocial p.d. Antisocial P.D. is one of the more common personality disorders (about 4% of people) The Grinch ? Scar (from the Lion King) ? Ted Bundy, serial killer The Mind of a Murderer: The Hillside Strangler(s) The “Dark Triad” of Personality Traits Narcissism Psychopathy Machiavellianism = seeing other people as a means-toan-end; being manipulative. Is Antisocial P.D. related to childhood Conduct D/O? Antisocial P.D. may be related to childhood conduct disorder, which can result from a combination of: – Neurological tendency toward cognitive deficits, plus – Difficult temperament, plus – Growing up in risky, tough environment, plus – Inadequate parenting Treatments for conduct disorder: – Cognitive-behavioral: re-interpret interpersonal interactions; self-talk to control impulsive behaviors; how to solve conflicts without aggression; get parents to reinforce positive behaviors; nonviolent discipline. – Medications: stimulants (like for ADHD); SSRI’s, SNRI’s; antipsychotic medications; lithium, antiseizure meds Possible Causal Factors for Antisocial P.D. Low emotional arousability (low fear or anxiety) – Seen in low heart rate & skin conductance, excessive slow-waves on EEG Stimulation-seeking (e.g., through fighting, risky behaviors) Deficits in executive cognitive functioning – Smaller prefrontal cortex in antisocial men; problems with empathy, problems with learning from punishment) Medical illness or toxin exposure during infancy & childhood Family relationships – Poor models – Parental rejection, maltreatment, abuse, loss Genetics – a factor particularly for criminal behaviors – Serotonin genes; can be related to impulsivity – Dopamine genes; related to reward seeking Sociocultural factors – Lower SES – Certain kinds of societies? Antisocial P.D. – Treatments (currently are typically ineffective) Work on anger and impulse control Increase understanding of effects on others Meds to help control impulsive or aggressive behaviors: – Lithium – Atypical antipsychotic drugs – Antiseizure drugs Borderline Personality Disorder (instability of identity) Enormous instability of mood, identity, & relationships Fears abandonment Impulsive Suicidal gestures, self-harm Anger-control problems Splitting (e.g., idealize & then devalue other) Chronic feelings of emptiness Dissociative symptoms: transient, stress-related Borderline P.D., cont. About 75% of those diagnosed are women. Lots of comorbidity, e.g., w/ eating disorders. Are high users of mental health treatment. Anakin Skywalker (?), Star Wars Alex Forrest, Fatal Attraction Possible Causal Factors in Borderline P.D. Unstable, abusive childhood – e.g, sexual abuse Fundamental deficits in emotional regulation Brain function: – Overly reactive amygdala (negative emotions) – Decreased activity in prefrontal cortex – Impulsivity can be assoc w low serotonin activity. Treatments for Borderline P.D. Dialectical behavior therapy: (DBT; Marsha Linehan) combines several approaches, including mindfulness See “Using Mindfulness to Regain Control During Crisis”: https://www.youtube.com/watch?v=MXxatFoSbeY Transference-focused psychotherapy Medications: can help quiet emotional storms, but do not treat the personality disorder Causes of Eating Disorders (Sociocultural, Psychological, & Biological) The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder Sociocultural Causal Factors Q: What aspects of our culture might encourage eating disorders? Some Relevant Cultural Forces: Patriarchy & Capitalism S Patriarchy: is a political-social system that socializes us all, telling us that “masculine” people/ things are more important, powerful, & valuable than “feminine” people/ things. Patriarchy is a cultural system that highly values men and “male” qualities, viewing them as central and important, while non-male people and qualities are not valued as much. S Consumerism/ Capitalism: places high priority on buying consumer goods and making monetary profit. Messages from Media & Advertising SThe Strength to Resist: Media’s Impact on Women: https://www.cambridgedocumentaryfilms.org/films Pages/resist.html (c. 30 min) S Jean Kilbourne: Killing Us Softly 4: Advertising’s Image of Women (45 min; is available on DVD in Rolvaag) Q: If cultural factors are so powerful, why don’t all Western women develop an eating disorder? Stice et al.: Are eating d/o symptoms related to exposure to media? Correlational study of 238 female undergrads. Used structural equation modeling. Found significant positive correlation, plus three mediating variables : S Endorsement of gender-role stereotypes S Internalization of ideal-body stereotype S Body dissatisfaction Stice et al Results, cont. Fredrickson et al. (1998), That Swimsuit Becomes You: Self-Objectification Theory S Objectification theory: “American culture socializes women to adopt observers’ perspectives on their physical selves.” S Self-objectification: Women treat themselves as an object to be evaluated on the basis of appearance. S This self-objectification can be a trait or a state. S Self-objectification è self-consciousness and ê mental resources available for other tasks. Frederickson et al.’s Studies Experimental study with undergrads: S Participants randomly assigned to try on a sweater or a bathing suit to “evaluate the clothing.” S Participants also completed a body shame measure, a food taste test, and a math test. Fredrickson et al.’s Findings S Bathing suit/Self-objectification è Increased shame - for women only, and this related to restrained eating. S Bathing suit/Self-objectification è Decreased math performance - for women only. ********* S Conclusion: Self-objectification’s emotional & behavioral consequences were seen more in women than in men. Other Psychological Causal Factors in Eating Disorders S Behavioral: conditioned fear of fat; rewards for being thin; modeling S Cognitive: body perception inaccuracy; overvalue appearance; dichotomous reasoning; mental filter; catastrophizing S Family structure: enmeshment S Emotion regulation (& psychodynamic) S Personality factors: low SE, autonomy & control issues, desire to please, perfectionism Biological Causal Factors in Eating Disorders S Genetics S Anorexia: MZ = 70%; DZ = 20% S Bulimia: MZ = 23%; DZ = 9% S Neurotransmitters: Serotonin, glutamate, dopamine activity? S Brain circuits related to GAD, OCD, & MDD? (don’t know if it’s cause or effect, though) S Hypothalamus regulates appetite and eating Treatments for Eating Disorders S Psychoeducation to recognize, challenge, and change cultural and media influences S Nutritional rehabilitation: Correct dangerous eating patterns, and for anorexia, gain weight quickly (feedings, rewards; motivational interviewing) S Psychotherapy: Address underlying psychological and situational issues (e.g., cognitive-behavioral therapy, insight therapy, family therapy, exposure and response prevention) S Antidepressant medications for bulimia Eating Disorders The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder S (Obesity is not listed as a disorder) “Quiz”: What features do anorexia and bulimia share? S Intense preoccupation with & fear of gaining weight? S Refusal to maintain a healthy body weight? S Misperception of actual body shape? S Binging and purging? S Don’t think much about food? S Lack of awareness or denial that there is a problem? S Much higher prevalence among women than men? S Higher prevalence among transgender & nonbinary people than cisgender people? Some related vocabulary… S amenorrhea S lanugo S ipecac S electrolyte imbalances Anorexia nervosa S Excessively low body weight S Intense fear of gaining weight S Disturbance in way body shape is experienced S DSM-5 (unlike previous editions) does not include amenorrhea as necessary for diagnosis S Two types: restricting OR binge-eating/purging Anorexia: Kate’s Story S https://www.youtube.com/watch?v=tOouAmEEnlc Empress Elisabeth (“Sisi”) of Austria/Hungary, late 1800’s Her cousin’s (King Ludwig II) Neuschwanstein Castle in Germany Bulimia nervosa S Binge-eating plus compensatory behavior (at least average of once/week for 3 months) S Rapid consumption of large amount of food S Feel a lack of control during binge S Overconcern with body shape & weight; body dissatisfaction Binge-eating disorder (new diagnosis in DSM-5) S Recurrent binge-eating without compensatory behavior S At least once/week for 3 months S Feel lack of control, disgust with binge Other specified feeding or eating disorder S Most common eating disorder (4-5% of female population in U.S.?) S Are partial-syndrome eating disorders S A question for today: Is anorexia a disease, or a lifestyle choice, or something else? “Pro-Ana” Websites Causes of Eating Disorders Are eating disorders culture-bound disorders? We will consider sociocultural, psychological, and biological causal factors. “Normal Barbie” (by Nickolay Lamm) https://nickolaylamm.com/art-for-clients/what-would-barbie-look-like-as-an-average-woman/ “Shrinking Women” - a poem by college student Lily Myers S https://www.youtube.com/watch?v= zQucWXWXp3k&feature=youtu.be Eating Disorders The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder S (Obesity is not listed as a disorder) “Quiz”: What features do anorexia and bulimia share? S Intense preoccupation with & fear of gaining weight? S Refusal to maintain a healthy body weight? S Misperception of actual body shape? S Binging and purging? S Don’t think much about food? S Lack of awareness or denial that there is a problem? S Much higher prevalence among women than men? S Higher prevalence among transgender & nonbinary people than cisgender people? Some related vocabulary… S amenorrhea S lanugo S ipecac S electrolyte imbalances Anorexia nervosa S Excessively low body weight S Intense fear of gaining weight S Disturbance in way body shape is experienced S DSM-5 (unlike previous editions) does not include amenorrhea as necessary for diagnosis S Two types: restricting OR binge-eating/purging Anorexia: Kate’s Story S https://www.youtube.com/watch?v=tOouAmEEnlc Empress Elisabeth (“Sisi”) of Austria/Hungary, late 1800’s Her cousin’s (King Ludwig II) Neuschwanstein Castle in Germany Bulimia nervosa S Binge-eating plus compensatory behavior (at least average of once/week for 3 months) S Rapid consumption of large amount of food S Feel a lack of control during binge S Overconcern with body shape & weight; body dissatisfaction Binge-eating disorder (new diagnosis in DSM-5) S Recurrent binge-eating without compensatory behavior S At least once/week for 3 months S Feel lack of control, disgust with binge Other specified feeding or eating disorder S Most common eating disorder (4-5% of female population in U.S.?) S Are partial-syndrome eating disorders S A question for today: Is anorexia a disease, or a lifestyle choice, or something else? “Pro-Ana” Websites Causes of Eating Disorders Are eating disorders culture-bound disorders? We will consider sociocultural, psychological, and biological causal factors. “Normal Barbie” (by Nickolay Lamm) https://nickolaylamm.com/art-for-clients/what-would-barbie-look-like-as-an-average-woman/ “Shrinking Women” - a poem by college student Lily Myers S https://www.youtube.com/watch?v= zQucWXWXp3k&feature=youtu.be Eating Disorders The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder S (Obesity is not listed as a disorder) “Quiz”: What features do anorexia and bulimia share? S Intense preoccupation with & fear of gaining weight? S Refusal to maintain a healthy body weight? S Misperception of actual body shape? S Binging and purging? S Don’t think much about food? S Lack of awareness or denial that there is a problem? S Much higher prevalence among women than men? S Higher prevalence among transgender & nonbinary people than cisgender people? Some related vocabulary… S amenorrhea S lanugo S ipecac S electrolyte imbalances Anorexia nervosa S Excessively low body weight S Intense fear of gaining weight S Disturbance in way body shape is experienced S DSM-5 (unlike previous editions) does not include amenorrhea as necessary for diagnosis S Two types: restricting OR binge-eating/purging Anorexia: Kate’s Story S https://www.youtube.com/watch?v=tOouAmEEnlc Empress Elisabeth (“Sisi”) of Austria/Hungary, late 1800’s Her cousin’s (King Ludwig II) Neuschwanstein Castle in Germany Bulimia nervosa S Binge-eating plus compensatory behavior (at least average of once/week for 3 months) S Rapid consumption of large amount of food S Feel a lack of control during binge S Overconcern with body shape & weight; body dissatisfaction Binge-eating disorder (new diagnosis in DSM-5) S Recurrent binge-eating without compensatory behavior S At least once/week for 3 months S Feel lack of control, disgust with binge Other specified feeding or eating disorder S Most common eating disorder (4-5% of female population in U.S.?) S Are partial-syndrome eating disorders S A question for today: Is anorexia a disease, or a lifestyle choice, or something else? “Pro-Ana” Websites Causes of Eating Disorders Are eating disorders culture-bound disorders? We will consider sociocultural, psychological, and biological causal factors. “Normal Barbie” (by Nickolay Lamm) https://nickolaylamm.com/art-for-clients/what-would-barbie-look-like-as-an-average-woman/ “Shrinking Women” - a poem by college student Lily Myers S https://www.youtube.com/watch?v= zQucWXWXp3k&feature=youtu.be Eating Disorders The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder S (Obesity is not listed as a disorder) “Quiz”: What features do anorexia and bulimia share? S Intense preoccupation with & fear of gaining weight? S Refusal to maintain a healthy body weight? S Misperception of actual body shape? S Binging and purging? S Don’t think much about food? S Lack of awareness or denial that there is a problem? S Much higher prevalence among women than men? S Higher prevalence among transgender & nonbinary people than cisgender people? Some related vocabulary… S amenorrhea S lanugo S ipecac S electrolyte imbalances Anorexia nervosa S Excessively low body weight S Intense fear of gaining weight S Disturbance in way body shape is experienced S DSM-5 (unlike previous editions) does not include amenorrhea as necessary for diagnosis S Two types: restricting OR binge-eating/purging Anorexia: Kate’s Story S https://www.youtube.com/watch?v=tOouAmEEnlc Empress Elisabeth (“Sisi”) of Austria/Hungary, late 1800’s Her cousin’s (King Ludwig II) Neuschwanstein Castle in Germany Bulimia nervosa S Binge-eating plus compensatory behavior (at least average of once/week for 3 months) S Rapid consumption of large amount of food S Feel a lack of control during binge S Overconcern with body shape & weight; body dissatisfaction Binge-eating disorder (new diagnosis in DSM-5) S Recurrent binge-eating without compensatory behavior S At least once/week for 3 months S Feel lack of control, disgust with binge Other specified feeding or eating disorder S Most common eating disorder (4-5% of female population in U.S.?) S Are partial-syndrome eating disorders S A question for today: Is anorexia a disease, or a lifestyle choice, or something else? “Pro-Ana” Websites Causes of Eating Disorders Are eating disorders culture-bound disorders? We will consider sociocultural, psychological, and biological causal factors. “Normal Barbie” (by Nickolay Lamm) https://nickolaylamm.com/art-for-clients/what-would-barbie-look-like-as-an-average-woman/ “Shrinking Women” - a poem by college student Lily Myers S https://www.youtube.com/watch?v= zQucWXWXp3k&feature=youtu.be Eating Disorders The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder S (Obesity is not listed as a disorder) “Quiz”: What features do anorexia and bulimia share? S Intense preoccupation with & fear of gaining weight? S Refusal to maintain a healthy body weight? S Misperception of actual body shape? S Binging and purging? S Don’t think much about food? S Lack of awareness or denial that there is a problem? S Much higher prevalence among women than men? S Higher prevalence among transgender & nonbinary people than cisgender people? Some related vocabulary… S amenorrhea S lanugo S ipecac S electrolyte imbalances Anorexia nervosa S Excessively low body weight S Intense fear of gaining weight S Disturbance in way body shape is experienced S DSM-5 (unlike previous editions) does not include amenorrhea as necessary for diagnosis S Two types: restricting OR binge-eating/purging Anorexia: Kate’s Story S https://www.youtube.com/watch?v=tOouAmEEnlc Empress Elisabeth (“Sisi”) of Austria/Hungary, late 1800’s Her cousin’s (King Ludwig II) Neuschwanstein Castle in Germany Bulimia nervosa S Binge-eating plus compensatory behavior (at least average of once/week for 3 months) S Rapid consumption of large amount of food S Feel a lack of control during binge S Overconcern with body shape & weight; body dissatisfaction Binge-eating disorder (new diagnosis in DSM-5) S Recurrent binge-eating without compensatory behavior S At least once/week for 3 months S Feel lack of control, disgust with binge Other specified feeding or eating disorder S Most common eating disorder (4-5% of female population in U.S.?) S Are partial-syndrome eating disorders S A question for today: Is anorexia a disease, or a lifestyle choice, or something else? “Pro-Ana” Websites Causes of Eating Disorders Are eating disorders culture-bound disorders? We will consider sociocultural, psychological, and biological causal factors. “Normal Barbie” (by Nickolay Lamm) https://nickolaylamm.com/art-for-clients/what-would-barbie-look-like-as-an-average-woman/ “Shrinking Women” - a poem by college student Lily Myers S https://www.youtube.com/watch?v= zQucWXWXp3k&feature=youtu.be Eating Disorders The Eating Disorders in DSM-5-TR: S Anorexia nervosa S Bulimia nervosa S Binge-eating disorder S Other specified feeding or eating disorder S (Obesity is not listed as a disorder) “Quiz”: What features do anorexia and bulimia share? S Intense preoccupation with & fear of gaining weight? S Refusal to maintain a healthy body weight? S Misperception of actual body shape? S Binging and purging? S Don’t think much about food? S Lack of awareness or denial that there is a problem? S Much higher prevalence among women than men? S Higher prevalence among transgender & nonbinary people than cisgender people? Some related vocabulary… S amenorrhea S lanugo S ipecac S electrolyte imbalances Anorexia nervosa S Excessively low body weight S Intense fear of gaining weight S Disturbance in way body shape is experienced S DSM-5 (unlike previous editions) does not include amenorrhea as necessary for diagnosis S Two types: restricting OR binge-eating/purging Anorexia: Kate’s Story S https://www.youtube.com/watch?v=tOouAmEEnlc Empress Elisabeth (“Sisi”) of Austria/Hungary, late 1800’s Her cousin’s (King Ludwig II) Neuschwanstein Castle in Germany Bulimia nervosa S Binge-eating plus compensatory behavior (at least average of once/week for 3 months) S Rapid consumption of large amount of food S Feel a lack of control during binge S Overconcern with body shape & weight; body dissatisfaction Binge-eating disorder (new diagnosis in DSM-5) S Recurrent binge-eating without compensatory behavior S At least once/week for 3 months S Feel lack of control, disgust with binge Other specified feeding or eating disorder S Most common eating disorder (4-5% of female population in U.S.?) S Are partial-syndrome eating disorders S A question for today: Is anorexia a disease, or a lifestyle choice, or something else? “Pro-Ana” Websites Causes of Eating Disorders Are eating disorders culture-bound disorders? We will consider sociocultural, psychological, and biological causal factors. “Normal Barbie” (by Nickolay Lamm) https://nickolaylamm.com/art-for-clients/what-would-barbie-look-like-as-an-average-woman/ “Shrinking Women” - a poem by college student Lily Myers S https://www.youtube.com/watch?v= zQucWXWXp3k&feature=youtu.be