PSY 183 Final Fair Game Sheet PDF

1 PSY 183 Final Fair Game Sheet I. BE ABLE TO DESCRIBE, DEFINE, OR ANSWER QUESTIONS RELATED TO: Stress Disorders ​ Reactions to extreme trauma ○​ Intrusive recollections ​ Daytime flashbacks, nightmares, illusions ​ Example of illus...

1 PSY 183 Final Fair Game Sheet I. BE ABLE TO DESCRIBE, DEFINE, OR ANSWER QUESTIONS RELATED TO: Stress Disorders ​ Reactions to extreme trauma ○​ Intrusive recollections ​ Daytime flashbacks, nightmares, illusions ​ Example of illusion) A veteran is in an argument with another person and begins to see the face of a combat enemy from a traumatic experience ​ Acute distress upon cues of the trauma ​ Example) A 4th of July parade with loud fireworks causes stressful flashbacks for veteran involved in IED explosion ○​ Dissociative symptoms “psychic numbing” ​ Emotional detachment ​ Being in a “daze” or being “zoned out” all the time ​ Dropping out of usual activities or going “off the grid” ​ Avoidance of topics related to trauma ​ Memory fog or “dissociative amnesia” (e.g., combat-related) ​ Time distortion (often feels slow) ​ “Dreamlike” sense of surroundings (derealization) ​ “This can’t be real” ​ Feeling detached from one’s own body (depersonalization) ○​ Chronic hyperarousal ​ Startle response, insomnia, hypervigilance, restlessness ○​ Irritability, unprovoked angry outbursts, and aggressiveness (especially in males) ○​ Survival guilt/shame ​ Feelings of unworthiness or being marginalized ○​ Reckless, impulsive behaviors ​ May be related to survival guilt/shame since people may be trying to hasten their own death ​ Experiences of depersonalization and derealization ○​ Depersonalization: Feeling detached from one’s own body or self, as if observing from outside. ○​ Derealization: Surroundings feel unreal, dreamlike, or distorted. ○​ Common symptoms: ​ Emotional numbness or detachment ​ Lack of connection to one’s own thoughts or actions ​ Perception of time slowing or speeding up  2 ​ Environment may feel foggy, distant, or visually altered ​ Acute Stress Disorder and PTSD: basic difference, risk factors, treatment ○​ Basic Difference: ​ ASD is a short-term response to trauma, with symptoms lasting 2 days to under a month, while PTSD is diagnosed when symptoms persist beyond a month. ASD can include intense anxiety, withdrawal, and sleep disruptions, and often occurs after accidents or interpersonal trauma (20-50% cases). ○​ Risk Factors: ​ Both ASD and PTSD risk increases with the severity, duration, and nature of trauma, pre-existing anxiety or depression or family history of those conditions, family history of PTSD, minority status, poor coping mechanisms, and lack of social support. ○​ Treatment: ​ Exposure therapy and CBT are primary treatments, focusing on desensitizing trauma responses and reinterpreting traumatic events. EMDR and polyvagal therapy are used but are based on controversial models. Stress management and supportive group therapy may also aid in recovery. ​ Nature of “Delayed Expression” syndrome ○​ Signs/symptoms are insufficient in acute phase for a diagnosis, but increase over succeeding months to the point that they are diagnosable as PTSD ​ “Stress was incubating” ​ This is more common when initial symptoms are mild or when social or mental barriers prevent immediate symptom expression ​ Complex PTSD – etiology and differences from PTSD ○​ Special case of PTSD reserved for repeated or continuous trauma over months or years ○​ Symptoms can be more extreme and longer-lasting than with “simple” PTSD ○​ Common kinds of CPSTD trauma: ​ Being a victim of neglect or emotional, physical and/or sexual abuse ​ Growing up in a family with domestic abuse ​ Being a POW or living in a war zone ​ Being a victim of human trafficking ​ Having a series of illnesses, medical procedures, surgeries ○​ Associated w/ usual PTSD signs and symptoms but also: ​ changes in worldview, religion, philosophy, basic trust, and views of relationships ​ preoccupation with traumatic history and revenge fantasies toward abusers ○​ Controversial diagnosis: the debate is mostly over whether CPTSD is simply severe PTSD. ​ Critical Incident Stress Debriefing: Basic steps ○​ Fact phase: Ask victims to tell their stories. ○​ Reaction phase: Ask victims to report their thoughts and feelings about the incident. ○​ Symptom phase: Solicit symptomatology and suggest coping strategies. ○​ Teaching phase: Educate victim regarding traumas and typical reactions to trauma. ○​ Reentry phase: Wrap-up, answer Q’s, provide referrals, develop plan of action.  3 ​ Note: Little evidence that such debriefings have much effect in reducing subsequent sign/symptom development. ​ 1st-line Psychotherapy treatment, and typical medication treatments for PTSD ○​ 1st-line psychotherapeutic treatment: exposure therapy relying on visualization of trauma-related cues, combined with relaxation, to extinguish conditioned fear responses ○​ Cognitive-Behavioral Therapy focused on “thought neutralizing” and finding new ways to interpret and live with trauma ○​ EDMR ○​ Polyvagal therapy focused on bodily awareness and anxiety reduction ○​ Group therapy ○​ Stress management training ○​ Medication treatment: ​ Symptomatic care: ​ Anxiolytics for short-term anxiety and panic attacks. ​ Antidepressants for chronic depression, anxiety, and irritability. ​ Antipsychotics for paranoia, social estrangement, and psychotic symptoms. ​ Sleep medications for insomnia. ​ Cannabinoids for anxiety in individual cases but can worsen PTSD symptoms and hinder treatment. ​ Specialized medications: ​ Antihyprtensive medication Prazosin reduces anxiety spikes, flashbacks, and nightmares by stabilizing the Sympathetic Nervous System. Works best in hypertensive individuals. ​ Experimental treatments: ​ Propranolol: May reduce PTSD memory intensity; unproven long-term. ​ Psychedelics: MDMA, psilocybin, LSD, ketamine, DMT; promising but unverified. ​ Drawback of memory-dulling treatments: May impair natural coping processes and hinder emotional recovery. Personality disorders (and see Question II) ​ Predominant features of each Personality Disorder as presented in lectures and text, including Passive- Aggressive Personality Disorder (Provisional) ○​ Cluster A: Odd/Eccentric ​ Schizoid Personality Disorder ​ Detachment from social relationships. ​ Limited range of emotional expression. ​ Prefers solitary activities; little interest in intimacy or socializing. ​ Often appears cold or aloof. ​ Schizotypal Personality Disorder - Doc Brown (Back to the Future) ​ Acute discomfort in close relationships.  4 ​ Cognitive or perceptual distortions (e.g., magical thinking, odd beliefs). ​ Eccentric behavior or appearance. ​ Social anxiety related to paranoia rather than self-doubt. ​ Paranoid Personality Disorder ​ Persistent distrust and suspicion of others' motives as malevolent. ​ Reluctance to confide in others. ​ Misinterpretation of benign remarks or events as threatening. ​ Often grudging, unforgiving, or hypersensitive to criticism. ○​ Cluster B: Dramatic/Emotional ​ Antisocial Personality Disorder - The Joker (The Dark Knight) ​ Disregard for and violation of others' rights. ​ Deceptive, manipulative, impulsive, and often criminal behaviors. ​ Lack of remorse or empathy. ​ Irresponsibility in work and relationships. ​ Histrionic Personality Disorder - Regina George (Mean Girls) ​ Excessive emotionality and attention-seeking. ​ Dramatic, theatrical behavior to gain approval. ​ Easily influenced by others or circumstances. ​ Perception of relationships as more intimate than they are. ​ Borderline Personality Disorder - Annie Wilkes (Misery) ​ Instability in relationships, self-image, and emotions. ​ Impulsivity (e.g., reckless spending, substance abuse). ​ Intense fear of abandonment. ​ Episodes of anger, depression, and feelings of emptiness. ​ Narcissistic Personality Disorder - Miranda Priestly (The Devil Wears Prada) ​ Grandiosity, need for admiration. ​ Lack of empathy for others. ​ Sense of entitlement and belief in being "special." ​ Exploitative in relationships, with fragile self-esteem. ○​ Cluster C: Anxious/Fearful ​ Avoidant Personality Disorder - Chidi Anagonye (The Good Place) ​ Extreme sensitivity to criticism or rejection. ​ Avoidance of social interactions despite desire for connection. ​ Feelings of inadequacy and low self-esteem. ​ Reluctance to engage in new activities due to fear of embarrassment. ​ Obsessive-Compulsive Personality Disorder (OCPD) - Monica Geller (Friends) ​ Preoccupation with order, perfection, and control. ​ Inflexibility in morals, ethics, or values. ​ Excessive devotion to work at the expense of leisure or relationships. ​ Reluctance to delegate tasks or compromise standards. ​ Passive-Aggressive Personality Disorder - April Ludgate (Parks and Recreation) ​ Indirect resistance to authority or demands.  5 ​ Procrastination, forgetfulness, or intentional inefficiency. ​ Subtle expressions of hostility, such as sarcasm or stubbornness. ​ Chronic feelings of resentment and dissatisfaction. ​ Dependent Personality Disorder - ​ Excessive need to be taken care of, leading to clingy and submissive behavior. ​ Difficulty making everyday decisions without reassurance from others. ​ Fear of abandonment and inability to function independently. ​ Goes to great lengths to gain support, even at the expense of personal needs. ​ “Symptomatic treatment” for Personality Disorders ○​ Borderline Personality Disorder ​ Medication (Partially Effective): Used to treat specific symptoms, though effectiveness may vary. ​ Mood stabilizers, antidepressants, and anxiolytics may be prescribed, with caution due to high overdose risk. ​ Antipsychotics may be used for high anxiety or transient psychotic symptoms. ​ Treatment Approaches ​ Long-term Therapy: Essential for managing symptoms and building skills. ​ For children and adolescents: Family-therapy interventions and structured day programs with behavior management may be implemented for severe cases. ​ Short Hospital Stays: Recommended for episodes of abandonment depression, suicide attempts, or self-injurious behavior. ​ Highly Structured, Psychodynamic Therapy or Dialectical Behavior Therapy (DBT): DBT is the only data-supported treatment for BPD. ​ For Borderline Personality Disorder, also know: ○​ Risk factors ​ Early Physical or Sexual Abuse: Some cases are linked to childhood abuse, with associated PTSD symptoms. ○​ Etiological hypotheses ​ Failure to master separation/individuation from the mother. ​ Faulty family boundaries. ​ A pervasively invalidating environment. ○​ Explanation of self-mutilation and dissociation ​ Self-mutilation, such as cutting or burning, is often a way to cope with intense emotional pain or feelings of emptiness, providing a temporary sense of control or relief. Dissociation may occur in response to overwhelming stress, leading to a sense of detachment from oneself or reality. ○​ “Transient psychotic episodes” and “splitting”  6 ​ Transient Psychotic Episodes: Brief episodes of paranoia, depersonalization, or derealization triggered by stress, during which individuals may temporarily lose touch with reality. ​ Splitting: A defense mechanism where individuals view people and situations in extremes, shifting rapidly between idealizing someone as "all good" and devaluing them as "all bad" without a balanced perspective. ○​ Basic Elements of Dialectical Behavior Therapy ​ Core Elements of DBT: ​ “Manualized” therapy that gives structure to chaotic patients ​ Combines weekly individual and group sessions and “dairy cards” to track “therapy interfering behaviors” (e.g. suicidal thoughts, cutting, purging) ​ Acceptance/change strategies to help manage emotional dysregulation and impulsive behaviors ​ Four Key Modules: ​ Mindfulness: Accepting thoughts and feelings ​ Distress Tolerance: Calmly recognizing current situations ​ Emotion Regulation: Analyzing emotional reactions instead of becoming overwhelmed by them ​ Interpersonal Effectiveness: Assertiveness & problem-solving ​ For Antisocial Personality Disorder, also know: ○​ Relationships among psychopathy, sociopathy and Antisocial Personality Disorder ​ Psychopathy: Focuses on personality traits (e.g., superficial charm, lack of empathy). Some act in ways that involve repeated moral offenses and/or criminal acts. Not a formal DSM diagnosis. ​ Example) Ted Bundy ​ Sociopathy: Emphasizes environmental factors (e.g., upbringing). More impulsive and prone to emotional outbursts. These are people who are socialized into lifestyles that involve repeated moral offenses and/or criminal acts ​ Examples) Gangs, cartels, organized crime, black market operators ​ ASPD: Clinical diagnosis in the DSM-5, characterized by pervasive disregard for others' rights, beginning in childhood. Psychopathy and sociopathy are sometimes considered subsets of ASPD but not always interchangeable. ○​ Predominant features of Antisocial Personal Disorder, including when the diagnosis is usually made. ​ Called Conduct Disorder before the age of 18; ASPD is diagnosed after 18 ​ Lying, cutting school, sexual/physical assault, heavy drug/ETOH use, cruelty to animals and other humans ​ Continual violation of laws, social norms, and/or rights of others ​ Pattern of repeated lying ​ Impulsivity and reckless behavior  7 ​ Irritability and aggressiveness ​ Failure to obtain consistent work or honor financial obligations ​ Reckless disregard for safety of self or others ​ Lack of remorse ○​ Psychopathy: ​ Risk factors ​ Genetic Factors: Family history of antisocial behaviors or personality disorders. ​ Brain Abnormalities: Reduced activity or structural differences in the prefrontal cortex (impulse control) and amygdala (empathy and fear processing). ​ Environmental Factors: ○​ Early trauma or abuse. ○​ Inconsistent or neglectful parenting. ​ Neurochemical Imbalances: Abnormalities in serotonin and dopamine systems. ​ Etiological hypotheses ​ Neurobiological: ○​ “Cortical immaturity” (prefrontal area dysfunction) supported by PET scan/fMRI data ○​ Prefrontal cortex deficits impair decision-making and impulse control ​ Environmental: ○​ Early exposure to violence or neglect shapes antisocial traits. ○​ Genetic-Environment Interaction: Genetic predisposition may be triggered or amplified by environmental stressors. ​ Psychopathy and physiological arousal ​ Low, slow, or hypervariable arousal hypotheses, with relative sensitivity to reward and punishment ​ Evidence-based treatment ​ Only evidence based treatment for Antisocial PD psychopaths is incarceration ​ “Successful” psychopaths ​ Definition: Individuals with psychopathic traits who avoid criminal behavior and excel in certain environments. May evade the criminal justice and mental health systems; common and even useful in certain occupations ​ Traits: ○​ High intelligence, charm, and emotional detachment. ○​ Strategic thinking and risk-taking behavior. ​ Common Professions: Business executives, defense attorneys ​ Adaptive Use of Traits:  8 ○​ Leverage fearlessness, confidence, and manipulation to achieve success. ○​ Can maintain a facade of social normalcy while pursuing personal goals. ​ Contrast between OCD and Obsessive-Compulsive Personality Disorder ○​ OCD is a mental health disorder with clear episodes of obsessions and compulsions that cause distress, while OCPD is a personality disorder marked by pervasive patterns of perfectionism and control that individuals often see as acceptable or even advantageous. ​ Text Addendum: “Meaning and the Temporal Lobes: Is God in the Amygdala?” ○​ Amygdala is important part of what links our experiences with their meanings ​ Kluver-Bucy Syndrome: Destroyed amygdala in monkeys and they acted very strange as a result ​ Didn’t react to things properly; lost their appreciation of what certain objects were actually for ○​ TLE and dissociative phenomena ​ TLE is temporal lobe epilepsy ​ Confined to amygdala- Simple partial seizures ○​ Last less than 1 minute and don't impair consciousness, they just produce weird sensory experiences ​ Spread more widely within temporal lobe - Complex partial seizures ○​ May "blank out” for a minute or two and be completely unresponsive throughout, then appear disoriented/dazed ​ Defensive aggression: people with TLE sometimes feel extra threatened by everyday events and may be assaultive or damage property all out of proportion to provocation ​ Global personality changes ○​ Personality changes associated with Complex Partial Seizures (“Geschwind Syndrome”) ​ Obsession with detail and meaningfulness of trivia ​ Nothing is an accident ​ Talkativeness and excessive writing ​ Interpersonal viscosity ​ Stickiness, person never ends stories or conversations ​ Hypermorality and diminished sense of humor ​ Hyperreligiousity with expanded sense of personal destiny ​ People begin to feel more special and clued into things on deeper level ​ Fetishism and sexual disinterest Schizophrenia (and see Question II) ​ General features of psychotic disorders ○​ Hallucinations (perceptions without external stimuli, e.g., hearing voices)  9 ​ Vivid perceptual experiences that seem real but occur without an external stimulus ○​ Delusions (fixed, false beliefs, e.g., paranoia) ​ Fixed beliefs that are not amenable to change in light of conflicting evidence ○​ Disorganized thinking and speech ​ “Derailment” (loose associations) ○​ Disorganized motor behavior or catatonia ​ Chaotic or bizarre movements or postures ​ Definitions of Delusional Disorder, Brief Psychotic Disorder and Schizoaffective Disorder ○​ Delusional Disorder: ​ Having one or more delusions that persist for 1 month or longer without other psychotic signs/symptoms ○​ Brief Psychotic Disorder: ​ Definition: A psychotic episode lasting less than one month, often triggered by stress or trauma, with eventual full recovery. ​ Symptoms: Hallucinations, delusions, disorganized speech or behavior. ○​ Schizoaffective Disorder: ​ Definition: A hybrid disorder with features of schizophrenia (psychosis) and mood disorders (depression or mania). ​ Key Feature: Psychosis persists even in the absence of mood symptoms. ​ Dementia praecox and Bleuler’s view of primary vs. restitutional symptoms. ○​ Dementia Praecox (Kraepelin): Early-term schizophrenia, characterized as a chronic, deteriorative mental illness. ○​ Bleuler’s View: Focused on primary symptoms (e.g., thought disorder, ambivalence) vs. restitutional symptoms (secondary responses like hallucinations and delusions that work to restore a coherent inner world). ​ Typical manifestations of Schizophrenia ○​ Positive Symptoms: Hallucinations, delusions, disorganized speech/behavior. ○​ Negative Symptoms: Blunted affect, social withdrawal, lack of motivation. ○​ Cognitive Symptoms: Impaired attention, memory, and executive function. ​ Risk factors: Genetic predisposition, consanguinity, concordances (you do not need to remember specific concordances), infectious agents, birth trauma, sperm, etc. ○​ Genetic Predisposition: Higher risk with first-degree relatives or twin concordance. ○​ Maternal ○​ Infectious Agents: Maternal exposure to viruses (e.g., influenza) during pregnancy. ○​ Birth Complications: Hypoxia, premature birth, low birth weight. ○​ Paternal Age: Older paternal age increases risk. ○​ Cannabis ​ Seasonality effects in schizophrenic births ○​ Higher rates of schizophrenia in people born during winter/early spring, possibly due to maternal infections during pregnancy. ​ Factors involved in violence by people with Schizophrenia.  10 ○​ Co-occurring Conditions: Substance abuse increases risk. ○​ Delusions: Paranoid or persecutory delusions may contribute. ○​ Non-Adherence to Treatment: Lack of medication increases the risk of violence. ​ Marijuana and Schizophrenic risk (and see Text Addendum “Does Marijuana Cause Mental Disorders” cited below) ○​ Increased Risk: Heavy marijuana use during adolescence is linked to earlier onset and higher risk of schizophrenia in genetically predisposed individuals. ○​ Possible Mechanisms: THC affects dopamine pathways and neurodevelopment ​ Positive vs. negative signs/symptoms of schizophrenia ○​ Positive Symptoms: Hallucinations, delusions, thought disorder (added behaviors). ○​ Negative Symptoms: Emotional blunting, social withdrawal, anhedonia (reduced behaviors). ​ Differences in positive- vs. negative- sign/symptom-predominant schizophrenia: ○​ Premorbid histories and course of illness ​ Positive: Often acute onset; better premorbid functioning ​ childhood oddity, irritability, aggressiveness ​ Less chance of observable brain damage ​ Better prognosis (tend to do better, live more normal life over time) ​ Negative: Gradual onset; poorer premorbid functioning; chronic, deteriorating course ​ Childhood withdrawal, passivity ​ Greater chance of observable brain damage ​ Worse prognosis (doesn't usually get better over time) ○​ Sex differences ​ Positive: females > males ​ Negative: males > females ○​ Differences in age of onset, prognosis ​ Positive: later age diagnosis (20-25) ​ Negative: earlier age of diagnosis (16-18) ○​ Neuroanatomical / neurotransmitter changes ​ Positive: frequent abnormal dopamine-turnover findings ​ Negative: infrequent abnormal dopamine-turnover findings ○​ Differences in medication effectiveness ​ Positive: Good response to classical antipsychotic meds ​ Negative: Poor response to classical antipsychotic meds ​ Classical / second generation (atypical) antipsychotic medications: ○​ Motor and metabolic side effects of antipsychotic medications ​ Classical: Higher risk of motor side effects; lower brain DS turnover by blocking DA receptors and induce Parkinson's-like symptoms (e.g., tardive dyskinesia: lip puckering, tongue/limb writhing, pseudoparkinsonism). ​ Atypical: Increased metabolic side effects (e.g., weight gain, type 2 diabetes, elevated blood lipids).  11 ○​ Overall compliance rate with antipsychotic medications ​ Less than 30% ​ There are alternatives where meds are released slowly for people that are not compliant ○​ Advantages of second generation (atypical) antipsychotic medications ​ Fewer motor side effects ​ Good at addressing both positive and some negative symptoms ​ Role of psychotherapy in schizophrenia ○​ Individual and family psychotherapy ​ Adjustment to illness ​ Family, friends, work, love ​ Deal with patient’s depression, anxiety resulting from knowledge of primary diagnosis ​ Symptom self-monitoring ​ Building compliance with medication (help talk through their worries about taking medication) ​ World-wide trends in schizophrenia incidence and possible explanations ○​ ​ Overall outcomes in schizophrenia ○​ Feeding and Eating Disorders (and see Question II) ​ General description of Avoidant/Restrictive Food Intake Disorder ○​ Description: Picky eating or disinterest in food leading to significant weight loss ​ Begins in childhood; affects males and females equally. ​ Extreme picky eating due to sensory sensitivities; no body image concerns. ​ Causes weight loss, nutritional deficiencies, and dependence on supplements. ​ Linked to choking incidents, ADHD, Autism, or learning difficulties. ​ Treated with nutritional counseling, CBT, and medications. ​ Prevalence of eating disorders as a function of sex and Westernization, and explanations ○​ Primarily affects females. ○​ Higher familial co-morbidity rates. ○​ Often co-occurs with anxiety and substance use disorders. ○​ Predominantly found in Western countries, linked to cultural ideals about food and femininity. ○​ Rising in non-Western countries with Westernization (e.g., workforce changes, media exposure, thinness as status). ​ Types of males who are especially susceptible to eating disorders ○​ Males in sports that emphasize thin-ness or weight control (wrestling, boxing, crew, jockeying), or in competitive body building ○​ Males in the gay social scene ​ Eating disorders: be able to define or identify from brief case descriptions  12 ​ Effectiveness of dieting as a weight-loss method. ○​ About 95% of diets fail as a means of weight loss ​ They can produce short term weight losses but the weight is almost always quickly regained and more ○​ Only long term successful weight loss method is a major lifestyle change ​ Semaglutide/Tirzepatide use in eating disorders ○​ Medications: Semaglutide (Wegovy, Ozempic, Rybelsus) and Tirzepatide (Mounjaro). ○​ Mechanism: GLP-1 agonists mimic natural peptides to lower blood sugar and reduce appetite. ○​ Approvals: Initially for diabetes; Wegovy approved for weight loss in 2023, with more approvals expected. ○​ Effectiveness: Clinical trials show an average weight loss of 15% body weight. ○​ Side Effects: Nausea, vomiting, diarrhea, abdominal pain, constipation, headaches. ○​ Applications: Being integrated into weight-loss programs; potential to treat obesity, diabetes, heart disease, alcohol use disorder, and dementia. ​ Being explored for binge eating disorder to control overeating ​ Anorexia Nervosa ○​ Nature of body-image distortion ​ Person “feels fat” and believes they are fat even when obviously underweight ○​ Susceptible populations ​ Most common for women in post-industrialized, high-income countries ​ May be more frequent in female athletes and dancers, among gay or bisexual males, and in male wrestlers, jockeys, runners, or models who must “make weight” ​ People with relatives with Anorexia (10-12 times more likely of developing the disorder themselves) ○​ Altered eating habits ​ Restrictive Type: ​ Obsessive thinking about food ​ Irrational food rules (e.g., only eating green foods, limiting portions). ​ Food rituals (e.g., sipping water between bites, excessive chewing before swallowing). ​ Binge-eating/Purging Type: ​ About 50% engage in binge eating and purging, typically through excessive exercise rather than vomiting. ​ Comorbidity: ​ Up to 70% of those with anorexia nervosa also have OCD ○​ "Two P's" of Anorexia Nervosa ​ Powerlessness & Perfectionism ​ “If I can control my body, then I can have a “perfect body” and a “perfect life.” ○​ Bodily damage suffered in Anorexia Nervosa  13 ​ Dry skin, thinning hair, patchy hair loss, brittle nails, always feeling cold. ​ Cyanosis (blueing) of toes and fingernails. ​ Chronic constipation. ​ Enlarged parotid salivary glands (“chipmunk cheeks”) and tooth erosion if there is induced vomiting ​ Chest pain and palpitations. ​ Muscle wasting and osteoporosis (loss of bone density) ​ Loss of brain volume due to cerebral atrophy. ○​ How Anorexia Nervosa is treated, and typical treatment outcome ​ Denial of illness is a major challenge, with patients often resisting weight gain. ​ Medical management for physical illnesses resulting from starvation. ​ Hospital re-feeding (via IV or nasogastric tube initially, progressing to oral feeding with social reinforcement), necessary if weight drops below 75% of body weight. ​ Note: rapid re-feeding can be fatal. ​ Residential treatment centers may be used for intensive care. ​ Inpatient to outpatient family therapy: ​ Patients regain control over eating, and slow re-feeding is introduced. ​ Psychotherapy: Long-term outpatient therapy is generally helpful. ​ Medication: Limited effectiveness, but Prozac (SSRI) and Zyprexa (major tranquilizer) may help with accompanying depression and anxiety. ​ Typical treatment outcomes: ​ 40 % - Complete recovery (takes 4-7 years) ​ 30 % - Partial recovery with relapses ​ 30 % - Persistent anorexia nervosa ○​ Poor social and occupational functioning ○​ 10-25% mortality rate, usually from cardiac complications or suicide ○​ Sufferers of anorexia nervosa die by suicide at rates 18X as high as non-anorexic comparison groups ​ Bulimia Nervosa ○​ Susceptible populations ​ Primarily affects adolescents/young adults ​ 80% of cases in females. Peak age: 15-18 for females, and 18-26 for males. ​ Up to 50% of people with bulimia have a history of Anorexia nervosa. ​ Among college students, prevalence may be as high as 10%. ​ The "Freshman 15" (unwanted weight gain) may contribute to high prevalence, though students typically gain about 4 lbs during the first 3 months, not the full 15 lbs. ​ Brain studies show multiple abnormalities in brain systems (unclear whether these are causes or effects)  14 ○​ Types of compensatory behavior among people with Bulimia Nervosa ​ Self-induced vomiting: Vomiting after binge eating to remove calories, leading to dehydration, tooth erosion, and digestive issues. ​ Excessive exercise: Engaging in extreme physical activity to burn off calories, which can cause exhaustion, injuries, and mental health problems. ​ Fasting: Restricting food intake after a binge to "make up" for overeating, leading to malnutrition and further binge-purge cycles. ​ Misuse of laxatives, diuretics, or enemas: Using substances to reduce calorie absorption or water weight, causing dehydration, digestive issues, and long-term health damage. ○​ Bodily damage suffered in Bulimia Nervosa ​ Most of the damage is from repeated vomiting: ​ Rupture of stomach or esophagus; blood in vomitus. ​ Heart damage from loss of electrolytes (mainly, potassium) ​ Osteoporosis (weakening of bones from Ca++ loss) ​ Erosion of teeth, gums and fingernails ​ Broken blood vessels in the eyes ​ Swollen parotid (cheek/jaw salivary) glands (“chipmunk cheeks”) ​ Females: Menstrual irregularities (amenorrhea in 50%, irregular periods in remainder) and higher risk of pregnancy complications. ​ Also associated with: ​ high (30 to 70%) rates of ETOH and/or drug use disorders ​ smoking (in order to maintain weight) ​ other impulsive behavior (sexual promiscuity, cutting, kleptomania). ​ self-harm in the form of cutting, burning, punching/slapping, etc. ○​ How Bulimia Nervosa is treated, and typical treatment outcome ​ First-line treatment: High doses of SSRIs (e.g., Prozac) to reduce bingeing and vomiting. ​ Therapy: Includes support groups, cognitive-behavioral therapy (CBT) to challenge body image issues, diary-keeping for triggers, and nutritional rehabilitation. ​ Long-term treatment: Typically successful (70-90%), but relapse is common and full recovery is rare. ​ Binge Eating Disorder ○​ Differences from Bulimia Nervosa ​ Binge eating disorder involves recurrent binge eating without compensatory behaviors (e.g., vomiting, exercise). ​ Bulumia includes binge eating followed by purging behaviors (e.g., vomiting, excessive exercise). ○​ Physical and psychological costs ​ Physical Costs  15 ​ Increased risk of obesity, heart disease, type 2 diabetes, obstructive sleep apnea, acid reflux, joint pain, early mortality, and hypertension due to repeated overeating. ​ Gastrointestinal issues from excessive eating. ​ Psychological Costs ​ Shame, guilt at binging behavior ​ Social avoidance in order to binge, and embarrassment at appearance ​ Depression and anxiety Substance Abuse/Dependence: ​ Moral vs. Medical (Disease) views of “addiction” ○​ Moral: Addicts are morally weak, choose to yield to temptation, and are consciously self-destructive and uncaring about the damage they cause others. They need to start making good choices and “get their act together” ○​ Medical (Disease): Possibly aided by a genetic predisposition and/or social learning, addicts begin using voluntarily, but then have their brains biologically “hijacked” by the addictive substances. They need treatments that block the hijacking, restore normal brain function, and thereby give them back their “will” ​ “Use” vs. “abuse” and sociocultural norms ○​ Use: ingesting a drug in accordance within sociocultural norms (what should be consumed, when it can be consumed, who can consume them, how much should be consumed, and what range of reactions is permissible) ○​ Abuse: taking a drug outside of sociocultural norms, causing personal and social problems as a result ​ Overall differences among substance intoxication, abuse and dependence ○​ Intoxication: Ingestion of a substance leading to (typically reversible) impairment. ​ Withdrawal: Signs and symptoms associated with metabolism of substance, usually opposite to those of ingestion. ○​ Abuse: Harmful pattern of use, e.g., regular periods of intoxication (and withdrawal). ○​ Dependence: Habitual abuse, and development of “cravings” and tolerance (needing increasing amounts for desired effects). ​ Risk factors for ETOH dependence; Level of Response and predisposition to ETOH dependence ETOH withdrawal symptoms and management ○​ Risk factors: ​ Time of first drink: People who begin drinking before age 15 are 4 times as likely to become ETOH-dependent, compared to those whose first drink is at age 20 or older ​ Age: About half of ETOH-dependent people in the U.S. are adolescents or young adults ​ Sex: Males are 4 times as likely as females to have ETOH use disorders ​ Personality: Impusive, sensation seeking traits, unstable personality disorders, or history of conduct disorder ​ Social: Peer pressure, availability of ETOH  16 ​ Education: College students drink more, especially those involved in Greek life ○​ Level of Response ​ People who need more ETOH to get a buzz are likelier to develop ETOH use disorders ○​ Family history ​ More than half of current drinkers have family history of ETOH abuse/dependence ​ Children of people who are ETOH-dependent are 4 times as likely to be dependent themselves ○​ Etnicity ​ Asians have lowest rate of ETOH abuse ​ Native Americans, Alaskan natives, and Mexican hispanics have highest U.S. rates of ETOH use disorders ​ Contributors to current U.S. opioid crisis ○​ ​ Current strategies for dealing with opioid crisis ○​ Physician Training: Improved pain management education; limit opiate use to