PSYC 260 Exam 2 Notes PDF

Oct 2-15 Chapter 7: Trauma and Dissociation Trauma and stressor-related disorder - Disorder develops after a stressful or traumatic life event - Two people can be in an accident but it’s possible for only one of them to get PTSD - Includes: Childhood attachment disorders - w...

Oct 2-15 Chapter 7: Trauma and Dissociation Trauma and stressor-related disorder - Disorder develops after a stressful or traumatic life event - Two people can be in an accident but it’s possible for only one of them to get PTSD - Includes: Childhood attachment disorders - where something has gone wrong in childhood and attachment develops Adjustment disorders - excessive reactions to stress involve negative thoughts, strong emotions, and changes in behavior Post-traumatic stress disorder (PTSD) Acute stress disorder - similar to PTSD, just has a different time frame Post-truamatic stress disroder - Emotional disorder following a: Trauma (war) Physical assault, particularly rape Car accidents (witnessed and been in) Natural catastrophes Sudden death of a loved one Long-lasting severe emotional reactions Criteria for PTSD *(give patient the list of events that you could get PTSD from and if they don’t have any of them, you don’t need to go through this criteria because it could be another disorder)* A. Occurrence of a traumatic event B. Cognitive re-experiencing: nightmares or flashbacks, intrusive thoughts, emotional and psychological reactivity C. Avoidance: the intense feelings, thoughts, memories, cues, reminders of the event D. Negative mood/cognitive: loss of interest, detachment, forgetting the event, negative beliefs, blame, negative emotional state/inability to feel positive emotions E. Somatic: sleep problems, irritability, concentration problems, hypervigilance, startle response, recklessness - PTSD can only be diagnosed 1+ months after the traumatic event, not right after event - because vast majority of people will recover without issue from a traumatic event (a small portion will not) Timing of onset - PTSD: diagnosed 1+ months after event - Acute stress disorder: 3+ days and up until 30 days post-event; same symptoms as PTSD - Acute stress is somewhat predictive of PTSD PTSD Stats - 32% of survivors of rape meet criteria for PTSD - 15%-20% of auto-accident victims - 11% members of Canadian Armed Forces - Every first responder likely has symptoms - PTSD predicts suicide attempts - Proximity to event predicts diagnosis - higher chance of PTSD developing when you experience it yourself Groups with high rates of PTSD - First Responders Police officers experience approximately 3.5 traumatic events in a 6-month period Throughout career of 30 years - over 200 exposures PTSD prevalence: 57% for firefighters and 37.8% for military personnel Gender Minorities - LGBTQ+ individuals: ~4x more likely to experience violent assault (rape or sexual assault, robbery, and aggravated or simple assault) - LGBTQ+ individuals are at higher risk of developing PTSD Prevalence estimate: 48% of LGB individuals and 42% of transgender and gender-diverse individuals - Sexual minorities: 1.6 and 3.9x greater risk of probable PTSD than heterosexual counterparts PTSD Causes - Etiology partially known - Biological, psychological, social factors - Intensity and severity of trauma - No or little social support system - Damaged hippocampus - this is because of chronic arousal and stress hormones being secreted PTSD Treatment - Prolonged/Imaginal exposure, coping skills - focuses on the traumatic event by exposing people to the pieces of the event in a prolonged amount of time to try to undo the belief paired with relaxation - Cognitive processing therapy - focuses on the beliefs that people have after trauma to evaluate if it’s realistic or not - Eye-movement desensitization and reprocessing (EMDR) - moving your eyes in a specific way while you process traumatic memories - SSRIs (Prozac, Praxil) to relieve anxiety - Pairing medication with a psychological treatment/cognitive or behavioral skill is very important  - Imaginal exposure - doing the exposure in our minds (ex. write an imaginal exposure script with a detailed description of what the trauma was about) Other trauma-and stressor-related disorders - Adjustment disorders: anxious/depressive reactions to life stress (it is not a reaction to a traumatic event) Cause: identifiable stressor - Attachment disorders: disturbed and developmentally inappropriate behaviors before age 5 Cause: Inadequate/abusive child-rearing practices Other trauma-and stressor-related disorders - attachment - Reactive attachment disorder: very seldom seeks out a caregiver for protection, support, or responds to caregivers - Disinhibited social engagement disorder: no inhibitions whatsoever to approaching adults (ex. Kid going with a stranger without any fear) Dissociative Disorders (Changes in perception and alterations in personality or identity) - Depersonalization-Derealization Disorder A. Persistent/recurrent depersonalization, derealization, or both Outside observer of own body or mind Unreality, detachment to surroundings B. Reality testing remains intact Rare; onset follows traumatic event - Ways it presents: Cognitive and perceptual deficits occur Mind emptiness - difficulty absorbing new information Deficits in emotion regulation Dysregulation in the HPA axis Dissociative Amnesia - Generalized: inability to remember anything, including identity - very rare - Localized/selective: inability to remember specific events (usually traumatic) - duration varies - happens in late adulthood - Usually, adult-onset (most likely from a stressful or traumatic event) - Dissociative fugue: memory loss revolves around an unexpected trip(s) Intolerable situation left behind Rare - Dissociative trance disorder (DTD), a type of DID Diagnosed when somebody is in a trance state outside the norm Diagnosed if it’s causing persistent impairment in everyday life Rare Dissociative Identity Disorder (DID) - Adoption of many identities  - Several identities (alters) co-exist simultaneously - Complete fragmentation of identity - Incredibly rare - Base rate: the probability that an event will occur, or an outcome will come about, or that individuals will have a certain characteristic Dissociative identity disorder criteria A. Two+ distinct personality states; discontinuity in the sense of self, agency, affect, behavior, consciousness, memory, perception, cognition, sensory-motor function B. Recurrent gaps in memory of everyday events, personal information, traumatic events C. Distress or impairment D. Not a normal part of accepted cultural or religious practice Dissociative identity disorder characteristics - Host identity: asks for treatment - Switch: instantaneous transition from one personality 37% report changes in handedness to another (right hand in one identity and left hand in the altered identity and physical changes) Can DID be faked? - Alters may be created upon suggestions from a therapist - People with fragmented identities may not be consciously/voluntarily simulating DID - Changes in hippocampal and medial temporal activity after the switch DID stats - ~15 average alter personalities - High female-to-male ratio (9:1) - Onset in childhood (around the age of 7); lasts a lifetime - Frequency of switching diminishes with age - Uncertain prevalence rates - Highly comorbid - not reflective of the stress but of the severe trauma and abuse DID causes - Childhood abuse (physical and sexual) Take on different identities as escape is not possible Escape sought from physical and emotional pain (intolerable) - DID may be a subtype of PTSD - Suggestibility personality trait: the trait of being more suggestible to other people’s ideas or beliefs - Autohypnotic model: suggestible people may use dissociation as a defense against trauma - Less suggestible people may develop PTSD - Results of studies inconclusive so far - Biological Contributions: Roles of hereditary and environment debated  Temporal lobe epileptic seizures associated with dissociative symptoms Sleep deprivations DID treatment - Long-term psychotherapy Reintegrate separate personalities 22% success rate - Treatment similar to PTSD Oct 15-25 Chapter 8: Mood Disorders An Overview - Major depressive episode: severe depression or loss of interest/pleasure including cognitive symptoms Depression lasts at least two weeks General loss of interest Anhedonia: inability to experience pleasure - going to be on the midterm Behavioral and emotional shutdown - Maina: extreme pleasure in every activity Hyperactivity, rapid speech Flight of ideas - speech becomes incoherent because the individual is attempting to express so many exciting ideas at once Person may require hospitalization 7+ days Diagnosed when there is significant impairment - Hypomanic episode: not as severe as a manic episode No marked impairment in social or occupational functioning 4+ days Hypo=less The Structure of Mood Disorders - Unipolar mood disorder: mood remains at one pole of depression-mania continuum - Bipolar mood disorder: mood travels between depression-elation pols - Mixed features: mix of symptoms Depressive Disorders - Major Depressive Disorder (MDD) - The most severe depression in the DSM - Depression on its own (doesn't include any mania) - You have to have either criterion 1 or criterion 2 and if you have one of those you have to have 4 of the symptoms A. 5+ of following in a 2-week period; at least 1 is either (1) or (2) 1. Depressed mood most of the day, every day 2. Diminished interest or pleasure in almost all activities 3. Significant weight loss or weight gain or decreased/increased appetite nearly every day 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue/loss of energy 7. Worthlessness or excessive guilt 8. Concentration problems/indecisiveness 9. Recurrent thoughts of death, suicidal ideation, planning or attempt B. No previous manic/hypomanic episode at any point in their life - if they have had a manic episode at any time in their life you immediately cross out depression - Persistent Depressive Disorder (PDD) - less symptoms but it lasts a long time (chronic) A. Relatively unchanged depressed mood for 2+ years B. While depressed, 2+ of poor appetite/overeating, in/hypersomnia, low energy, low self-esteem, poor concentration or decision making, hopelessness C. Never w/o symptoms A or B for 2+ months D. Can meet MDE for 2+ years - Double depression - meets the criterion for persistent depressive disorder but they have periods that their mood worsens which can meet the criterion for MDD Persistent depression with periods of significantly worsening mood (MDE’s)  *This graph is going to be on the midterm but in a different order* a) Time: less than 2 years; Diagnosis: MDD with recurrent episodes b) Time: 2+ years; Diagnosis: PDD c) Time: 2+ years; Diagnosis: PDD with Major Depressive Episode (DSM-5) AKA double depression d) Time: less than 2 years; Diagnosis: MDD - chronic MDE with no remission e) Time: less than 2 years; Diagnosis: MDD with partial remission f) Time: less than 2 years; Diagnosis: MDD, recurrent episodes with partial inter-episode remission Depressive Disorders Specifiers - brief entry that tells us additional information on the presentation of someone's disorder - Specifiers: symptoms that may accompany a depressive disorder (tells us about the symptoms that someone is having and helps with which treatment is best) - Single or recurrent episode - Mild, moderate, severe always - Clinicians can use eight additional specifiers Specifiers (Do NOT need to memorize, just know there are a lot of them) 1. With psychotic features - mood disturbance accompanied by either delusions, hallucinations, or both 2. With anxious distress - feeling keyed up or tense, feeling restless, difficulty concentrating because of worry, fear that something awful might happen, and feeling that one might lose control  3. With mixed features - for the most part depressed with some manic or hypomanic symptoms 4. With melancholic features - early morning awakening, weight loss, loss of pleasure, and loss of reactivity to usually pleasurable stimuli 5. With atypical features - overeating, oversleeping, “leaden paralysis,” and interpersonal rejection sensitivity 6. With catatonic features - immobility (periods of not moving), mutism (inability to speak), posturing (holding unusual body positions), negativism (resisting instructions or not responding to what’s happening around you), stereotype movements (repeating behaviors over and over), grimacing (keeping the same facial expression, sometimes looking like a stiff smile), echolalia and echopraxia (mimicking someone else’s speech or movements) 7. With peripartum onset - depressive episode begin during pregnancy or within four weeks after giving birth 8. With seasonal pattern - recurrent episodes of depression in late fall and winter, alternating with periods of normal mood the rest of the year Example diagnosis: - Major Depressive Disorder, moderate, in partial remission, with anxious distress - Persistent Depressive Disorder, with anxious distress, with intermittent major depressive episodes, without current episode, mild Onset and Duration - ~25 years - Adolescent and girls’ prevalence is increasing (younger people are experiencing more depression than in previous generations) - 0.07% prevalence in children; 3%-6% prevalence in adults - Can last weeks to years for MDD - PDD may last decades - very chronic across time and might not experience remission during that time - Transgender youth nearly 4x higher rates of depression What can we do to prevent MDD: - Social programs - Extracurriculars - Protective social contact - Parents are the number one socialization agent/model so investing in parents - flexibility, educational programs, etc. - Invest in educational material about mental health - Education with mental health and connected with social media - Proper trained therapists or support in school system - Having the lowest threshold that you need in certain - minimum qualifications to provide Grief  - Experiencing death of a loved one leads to depressive symptoms - Integrated grief = what typically occurs when someone has started to accept the loss and started integrating what that means in their life (builds and builds until they reach acceptance - not fighting the reality) - Complicated grief = when the intensity of grief has not decreased in the months after your loved one’s death - Prolonged Grief Disorder - still very controversial - the loss you experience after losing someone is not pathological (added to DSM-5-TR in March 2022) - Grief is not linear - there is no normal pattern Other Depressive Disorders - Premenstrual Dysphoric Disorder Physical symptoms, severe mood swings, irritability/anger, severe depressed/anxiety during menstruation Not just menstruation symptoms - severe and debilitating 2-5% will experience these incapacitating functioning Often treated with a half course of SSRI (take it for a period of time in a cycle and then do not take it for the second half) - Disruptive Mood Dysregulation Disorder Chronic irritability, anger, aggression, hyperarousal, frequent temper tantrums 6-18 years of age only Childhood disorder - where some children differ from others as they have significant and inappropriate anger, irritability, frequent severe temper tantrums If identified at school the child is usually labeled as difficult when in reality they are suffering from a mental health disorder Manic Episode A. Abnormally and persistent elevated, expansive, or irritable mood, goal-directed activity, or energy for 1+ week Mania can be euphoric or dysphoric Positive and aligned and also possible that it’s not fully positive which often happens when people are aware that they are in a manic episode Typically, the first episode is euphoric so not typically motivated to stop feeling that way B. 3+ symptoms of following or 4 if mood is only irritable - Inflated self-esteem/grandiosity (an unrealistic sense of superiority) - Decreased need for sleep (feeling like they don’t even need sleep) - lack of sleep can trigger a manic episode - More talkative/pressured speech - unable to stop or pause at a normal rate or spaces - Flight of ideas/racing thoughts - Distractibility (focus turns to something else very quickly)  - Increased goal-directed activity - Involvement in high-risk activities (gambling, unsafe multi-partner sex capades) Bipolar Disorders - Bipolar I disorder One manic episode Can have depressive episodes Cycle between the two - Bipolar II disorder One hypomanic episode AND one major depressive episode Never full mania - Rapid-cycling specifier: 4 manic or depressive episodes within 1 year (4 mood shifts annually) More rapid in terms of days or weeks - ultra-rapid 24-hour ultra-ultra rapid cycling (most rare) More severe form and more treatment-resistant (especially with medications) - Cyclothymic disorder Causes emotional ups and downs that are less extreme than bipolar disorder Longer lasting and has to be at least 2 years More chronic, less severe Bipolar Disorders Onset and Duration - Average age of onset: Bipolar I disorder: 18 years Bipolar II disorder: 22 years (10%-13% progress to Bipolar I) Suicide risk increases with diagnosis Onset happens fast 60% of cyclothymic patients are women - onset in teens Prevalence of Mood Disorders - 2.6 million Canadians reported a mood disorder - Worldwide: 16% lifetime, 6% in preceding year - Lifetime prevalence of bipolar disorder (11%) in transgender people - Prevalence decreasing over time in Canada? - people seeking out support, less stigma around depressive disorders - Women 2X as likely as men to have depression but equal among bipolar I and II Culture and Mood Disorders - Somatic (body) - same; subjective - different - Somatic symptoms of depression: lack of appetite, muscle tension, fatigue, weight loss/gain - Subjective symptoms - More individualistic cultures (in Western cultures) - Canadian occurrence: moderate (8% prevalence)  Indigenous Peoples 3x-4x higher than Gen. pop Mood Disorder Causes Family and Genes - 2x-3x times higher in relatives of confirmed cases - Mood disorders heritable (37%) - Genetic contributions to depression may differ from mania - Familial Joint heritability - Close relationship among depression, anxiety, and panic - Genes also implicated People don’t always experience the same social and environmental situations Serotonin Hypothesis - Low levels of serotonin may impact mood - Serotonin regulates emotions - No test of serotonin levels in the brain - does not pass through the bloodstream Serotonin in the body is testable but it is different than the serotonin in your brain - Body serotonin does not cross the blood-brain-barrier Sleep & Circadian Rhythms - REM starts sooner after falling asleep in those with depression - Depressed experience more intense REM activity - Reduced slow wave/deep sleep in depression - Disturbed sleep produces problems across lifespan - Severe sleep problems in bipolar patients - First place in assessing what treatment is best, look at the person’s sleep routine and quality Stressful Life Events - In 60%-80% of cases, depression is caused by psychological experiences - Interpretation of stressful events - know for the test (ex. someone thinks it is the worst time ever when going to a club, and someone says it’s a good time) - Gene-environment correlation model - Stressful events provoke both relapse and prevent recovery Learned Helplessness Theory of Depression - Seligman: people become depressed when they feel they have no control over life’s stresses - Depressive attributional style is: Internal, Stable, Global - People have cognitions for three main areas - Internal - individuals attribute negative events to personal failings (“It’s all my fault”) - Stable - after something negative happens, whatever the outcome is it will stay and continue (enduring) - forever my fault - (ex. Once a failure, always a failure) - Global - applying these cognitions to a wide range of things (ex. I'm bad at everything) Negative Cognitive Styles - Beck: depression arises from interpreting everyday events negatively Cognitive errors: arbitrary inference (emphasizing the negative rather than the positive aspects of a situation) and overgeneralization (overgeneralizing from a small piece and applying it very broadly) - Cognitive triad: thinking negatively about the self, the immediate world, and the future Mood Disorders in Women - 70% of people with major depressive and persistent depressive disorders are women - Perceptions of uncontrollability - Other factors: Societal roles assigned to women, rumination, poverty, single mothers, abusive histories Social Support - Rate of depression 80% higher for those who live alone - Predicts onset of symptoms of depression - Enables faster recovery from depressive episodes and postpartum depression but not mania Psychosocial Treatment for Bipolar - Interpersonal and social rhythm therapy (IPSRT) - Family-focused treatment combined with medication - CBT effective for bipolar patients Treatments for Depression - Cognitive Behavioral Therapy Correcting cognitive errors Realistic thinking encouraged by monitoring and logging thought process Socratic questioning and cognitive restructuring Behavioral experiments and activation are encouraged - Electroconvulsive Therapy and Transcranial Magnetic Stimulation Electroconvulsive therapy (ECT): controversial, last-resort treatment ○ Safe and effective for those who do not respond to other treatments ○ Application of electrical impulses through the brain to produce seizures Transcranial magnetic stimulation (TMS): coil around your head, has an electromagnetic pulse, can be given daily, not much research on this treatment ○ Somewhat effective in treatment for depression Treatment Medications - Three basic types of antidepressant medication used: Tricyclics - inhibiting the reuptake of neurotransmitters, such as serotonin and norepinephrine (modulates mood, attention, and pain in individuals)  MAOIs (monoamine oxidase inhibitors) - prevent the breakdown of neurotransmitters like serotonin, norepinephrine, and dopamine in the brain (makes these chemicals available to change brain chemistry and circuits that are affected by depression) SSRIs (selective serotonin reuptake inhibitors) - drugs used to treat depression, anxiety, and other mental health conditions Lithium - most common for bipolar - Effective in preventing and treating manic episodes for 50% of patients Mood-stabilizing drug - Made of lithium salt - Doesn’t cure the symptoms - Has to be monitored (precise window for positive effects) - Should not be stopped right away (one day you take it, the next day you don’t) - unpleasant and bad effects on health Psychedelics for Mood Disorders - Systematic reviews and meta-analyses provide support for robust, rapid, and transient antidepressant and anti-suicidal effects of ketamine - Ketamine: atypical psychedelic, dangerous recreationally - Several trials in the last decade demonstrate antidepressant effect of psilocybin (magic mushrooms/shrooms) - Psilocybin was found to be comparable to escitalopram (SSRI) in one trial - The therapeutic effect appears to be dose-dependent on degree of mystical experience one has - the more profound the experience, the greater the therapeutic gains Suicide - About 800,000 people per year worldwide (lots of suicides are perhaps not classified as suicides so there may be missed numbers in statistics - underestimation) - In all countries but China, men are more likely to die by suicide than women Men typically pick more lethal methods such as hanging, shooting, etc. Women may choose less lethal methods such as pills, cutting to bleed out, etc. - Suicidal attempts (the person survives) - had the intent but an intervention occurred - Suicidal ideation (thinking seriously about suicide) - making a suicide plan Active suicidal ideation - present planning (prep to do it) ○ When assessing risk, when someone has intent (active) then there is a higher alarm and also a higher risk Passive - not this intention thinking maybe no intention but if I could opt out I would (Ex. if it happens it happens and I would not be upset about it) - Incidence higher in Indigenous Peoples, seniors, males, those with alcohol problems (depressant and lowers inhibitors so increase in impulsivity - ones to really look out for), transgender and LGBTQ+ folks  - Suicide ideation since pandemic (2.44%) not significantly different from 2019 (2.73%) in Canada - Suicide by suffocation or hanging now accounts for the majority of suicide deaths in both men and women in Canada - from textbook - Poison is declining and suffocation is increasing - Important to ask very direct questions - what is your plan, do you have access to the means, etc. Time frames - what things will push people over the edge People would usually tell therapist or psychologist after having built a strong therapeutic rapport If the open dialogue does not happen then things get missed The open and direct questions also create the air of it being an okay space to talk about the topics Create the space and do not use hesitant language - What can be very confusing for people - sometimes it is the case that the individual has been in despair making the plan can relieve the despair - create a semblance of positivity so sometimes the friends and family will see this can be confused about the way that the person is presenting themselves Hard to associate presentation of mood etc. with the risks of act - Essentially anyone who feels disconnected from others or themselves as they used to be may be more likely to have a higher risk - Textbook notes: Canada 2019 - suicide 9th rank among the ten leading causes of death but this varies by age As age goes up other thing things that can kill you like cancer and circulatory problems become higher in causes of death and suicide drops in rank A concern in older citizens due to decreased social support Strong relationship exists between illness or infirmity and hopelessness or depression Although more men die more, women attempt more often ○ This may be connected to depression rates - reflecting the fact that more women than men are depressed and that depression is strongly related to suicide attempts Between 16-30% of adolescents who had thought about killing themselves actually attempted (serious contemplation of the act) Suicide Risk Factors - Family History A suicidal family member (first degree = mom, dad, siblings…) Depression - ideation as a symptom Genetic - may run in the family  - Existing Psychological Disorders 90% have psychological disorders 60% suicides associated with mood disorders Hopelessness, alcohol abuse, impulsivity Stigma - Stressful Life Events Severe experiences: ○ Shame, humiliation, emotions we really hate so there is a higher risk and desire to escape them (the only escape for some people may be suicide), unexpected arrest, rejection (loved one, love interest), physical or sexual abuse, natural disasters (loss of environment) ○ Pre-existing vulnerabilities, lack of social support Suicide Intervention - Assess for possible ideation Suicide prevention and crisis centers Cognitive-behavioral interventions Coping-based interventions Stress reduction techniques - Quick intervention is key - The lines are most busy at night Oct 29 Chapter 9: Eating Overview of Eating Disorders - Bulimia nervosa: binging (out-of-control) eating episodes followed by self-induced purging - Anorexia nervosa: person eats minimal amounts or exercises vigorously - Binge-eating disorder: binging not followed by purging - Chronic - lasts a long time and could result in death - Always assess for risk of suicide - high rate for people with eating disorders - Increase in cases over last few decades - Culturally specific; going global - due to social media - Often, young females in socially competitive environment - comparing themselves to other people - Transgender college students 4X more likely than their cisgender female counterparts to report an eating disorder diagnosis Bulimia Nervosa Criteria A. Recurrent episodes of binge eating. All episode of binge eating is characterized by both of the following:  1. Eating, in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances 2. A lack of control overeating (e.g., a feeling that one cannot stop eating or control what or how much) B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain (ex. using laxatives, overexercising, self-induced vomiting, medications, excessive fasting) *was there a binge what did they do to compensate?* C. At least once/week for 3 months D. Self-evaluation influenced by body shape and weight Medical Consequences of Bulimia - Enlargement of salivary glands - due to excessive vomiting - Erosion of dental enamel - due to stomach acid coming up when vomiting - Electrolyte imbalance - Disrupted heartbeat, kidney failure - Intestinal problems - overusing laxatives - Marked calluses on fingers or back of hand - Often within 10% of normal body weight (not underweight because the calories have already been absorbed) Bulimia Comorbidity (two or more disorders occurring at the same time) - Anxiety most often and mood disorders - Depression, borderline personality disorder - Impulsivity - personality trait that has associations with bulimia - Substance use - Assessment drives treatment Anorexia Nervosa A. Restriction of energy intake, leading to a significantly low body weight B. Intense fear of gaining weight/becoming fat, or persistent behavior that interferes with weight gain, even though at significantly low weight* C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight - Two subtypes (last 3 months): Restricting type Binge eating/purging type Medical Consequences of Anorexia - Cessation of menstruation (amenorrhea) - Dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures - Lanugo - development of downy hair on the limbs and cheeks (trying to keep warm) - Cardiovascular problems  - Electrolyte imbalance Anorexia Comorbidity - Anxiety disorder - Mood disorders - OCD - Substance abuse - Suicide Binge-Eating Disorder A. Recurrent episodes of binge eating characterized by: 1. Eating in a discrete period of time, an amount of food that is definitely larger than what most people would eat 2. A sense of lack of control over eating during the episode B. The bing-eating episodes are associated with 3+ of: 1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of feeling embarrassed by how much one is eating 5. Feeling disgusted with oneself, depressed, or very guilty afterward C. Marked distress regarding binge eating is present D. At least once a week for 3 months E. Not associated with recurrent use compensatory behavior Eating Disorders Statistics - 90%-95% of those with bulimia are women - Age of onset: 15-19 years, chronic if untreated - Bulimia lifetime prevalence: 1.46% for women and 0.13% for men - Anorexia lifetime prevalence: 0.66% for women and 0.16% for men 20% of individuals with anorexia die from the disorder Suicide rate 50X higher in anorexia than gen. pop - Transgender men: anorexia nervosa (4.2%) and bulimia nervosa (3.2%) - Transgender women: anorexia nervosa (4.1%) and buulimia nervosa (2.9%) Cross-cultural considerations - Immigrants who recently moved to Western countries - Risk factors: higher social class, acculturating to the Western majority, being overweight - Cross-cultural differences diminishing Developmental Considerations - Girls have concerns about weight gain at puberty (gaining fat in different parts of body), boys less so (they gain muscle mass) - Found in children and older adults less often - Modeling not being satisfied (getting told to lose a couple of pounds or diet, pointing out weight gain in different areas) - mom to daughter  - ARFID (Avoidance Restrictive Food Intake Disorder) - an eating disorder that does not involve concerns of body appearance The concern with textures of foods, consequence of eating certain foods ○ Disgust reaction made to eat certain foods ○ Oversensitivity to smell, texture, or appearance of food Leads to nutritional deficiency or medical consequences Causes of Eating Disorders Social Dimensions - Sociocultural pressures (different societies have different beauty standards - sometimes not attainable) - Social media glorifies “slenderness” - Collision between culture and physiology - Increase in exercise programs - Dieting produces stress-related withdrawal symptoms in brain - Fighting biology - Pressure from family - Chronic dieting leads to preoccupation with food Biological Dimensions - Biological and genetic vulnerabilities - 4-5x greater likelihood of developing an ED in relatives of those with EDs - Perfectionist traits - if the mother has it, the daughter can get it too - May inherit tendencies to eat impulsively or to restrict eating Psychological Dimensions - Young women with eating disorders have: Diminished sense of personal control Lack of confidence in own abilities and talents Perfectionist attitude Low self-esteem Intense negative emotional reactions Distorted body image Treatment of Eating Disorders - Drug Treatments: Not useful for anorexia Antidepressants, Prozac for bulimia Drug therapies are less effective for EDs - Psychosocial Treatments: Short-term CBT CBT-E (cognitive-behavioral therapy-enhanced) Dropout rates: 20.2% to 51% (inpatient); 29% to 73% (outpatient) Family therapy Treatment of Bulimia Nervosa - CBT-E: alter dysfunctional thoughts, attitudes about body shape, weight, eating - IPT: improve interpersonal functioning - CBT: change eating habits and attitudes about food - Behavior therapy: change eating habits - Family therapy Treatment Binge-Eating Disorder - CBT - Weight-management programs - Self-help procedures - Treatment to be directed toward bingeing Treatment of Anorexia Nervosa - Hospitalization for weight gain - CBT-E - Outpatient CBT: nutritional counseling - Motivational enhancement techniques - Family therapy Preventing Eating Disorders - Eliminating exaggerated focus on body shape, weight - Educating about food and eating habits - Promoting a healthy body image - Countering effects of media portrayals of being thin