14bc Personality eating disorders Flashcards
Defense mechanisms
unconscious mental process that the ego uses to resolve conflicts. (i want to punch him but I know I shouldnt)
Personality parts
- 50% temperament “nature”
- Character
- Development- negative repeated childhood events can have negative effects
- Psyche- self awareness and ability to learn, adapt, and change
Immature defense mechanisms
Acting out
dissociation- drastic temporary change in personality etc.
Denial
Displacement- husband yells at wife- wife yells at child
fixation
identification- modeling behavior after someone more powerful
Isolation- separating feelings from ideas or events
Projection-projecting your own unacceptable impulses 2 someone else
Rationalization
Reactio formation- think of sex join monestary
regression- toilet trained child wets bed
Repression- involuntary witholding ffelings or thoughts from consciousness
splitting- all good or all bad- no inbetween
Mature defenses
Altruism- alleviating guilt by helping others
Humor- i.e. making a joke about Step 1
Sublimation- replace impulse with more acceptable one- angry at dad- take out frustrations scoring goals in soccer
Suppression- intentionally witholding thought or idea from consciousness- choosing not to worry because there are other things to do right now.
Personality disorder
- Ingrained.inflexible
- Gets in the way of realtionships or functioning
- Stays stable
- distresses people around them
Personality disorders stats
10-18% of population
30-50% psychiatric outpatient populations
>50% inpatient
34% of Axis 1 disorder patients
Cluster A
Detached and eccentric
- Schizoid
- schizotypal
- paranoid
Schizoid PD
Emotionally detached doesnt want relationships SchizoiD --> Distant *M>f *No positive symptoms of Schizophrenia
SchizoTypal PD
Eccentric/ awkward
magical Thinking
*genetic predisposition
“I dont like your vibe man”
Paranoid PD
pervasive distrust
M>F
No hallucnations or thought disorder
Cluster B personality disorders
Dramatic and imulsive
Antisocial
Borderline
Histrionic
Narcisistic
Borderline PD
- Frantic fear of abandonment
- Unstable and intense relationships- Idealization or devaluation
- mood swings (minutes to hours, not days like bipolar)
- suicide and self mutilation common
- F>M
- Familial- associated with MDD and substence abuse
Antisocial PD
Sociopath criminal, deceitful, impulsive Aggressive, irritable Irresponsible -M>F -very genetic
Histrionic PD
Paris hilton
sexually provocative, attention seeking, emotional and excitable
F>M
Narcissistic PD
*Self-important grandiosity- lack of empathy
*Success, pwer, brilliance, beauty, love
*arrogant, entitled, envious
*require admiration, take advantage of others
rages at criticism
Cluster C personalities
Cowardly, clingy, compulsive
- avoidant
- Obsessive compulsive
- Dependent
OCPD
*Fixated on details- lose scope
*Perfectionism that interferes
*Inflexible values that are unattainable
M>F
rationalize, intellectualize, reactionary, controlling
EGO SYNTONIC
Avoidant PD
- Extreme sensitivity to rejection with withdrawl
* Shy but desire relationships
Dependent PD
*subordinate needs to others
*indecisive- no self confidence
*doesnt speak up because of fear
*Cant be alone
F>M
PD treatments
*Psychodynamic treatment- change defenses
*supportive if patient unstable or unable to see problems
*Behavioral if behavior self destructive
Meds for symptoms
Anorexia nervosa
MOST LETHAL PSYCH DISORDER -intense weight loss and fear of obesity -Disturbed body image -medical signs and symptoms of starvation (May require inpatient) Dx Criteria *less than 85% of ideal weight *intense fear of gaining weight *Body image distortion *(amenorrhea)
Anorexia classifications
Purging/restricting
Severity Mild BMI>17 Moderate 16-16.99 Severe 15-15.99 Extree <15
Signs of starvation
Hypotension
Bradycardia
Hypothermia
- bradycardia, syncope, EKG changes, arrhythmias and suddendeath
- skeletal: osteopenia porosis
- Endocrine: decreased sex hormones, cold intolerance hypothermia, decr libido and amenorrhea
- Derm- dry skin, alopecia, lanugo
- Heme- pancytopenia
- GI- delayed gastric emptying constipation
- Neuro- fatigue, weakness, brain mass volume loss and cognative deterioration
Anorexia epidemiology
- 10:1 females to males
- Mid teens
- 1% population, 5% subclinical
- higher socioeconomic status
- Multifactorial, dieting common
- Genetic predisposition
Eating disorder psychological factors
- Temperment: perfectionism, harm avoidant, high achieving
- Control issues: feeling helpless, or controlled
- Maturation fears: doesnt want to be full woman
- demands to increase independence
- Greedy/unacceptable moral desires
Eating disorder social factors
Media Obesity ed Family weight concerns Teasing about weight dieting info performance pressures
*interfamily conflicts:
hostile, chaotic, isolative, controlling, not nuturing, not empathetic
AN treatment
- Hospitalization- slow refeeding
- Therapy
- family (maudsley -parents control at start then give to patient)
- individual - CBT and DBT
- group therapy
- STABALIZE AND IMPROVE RELATIONSHIPS
Prognosis:
75% good to moderate improvement, 1/4 complete recovery, 1/2 still issues but functiong, waxing and waning
Poor prognosis- persisting food obsessions, bulimia, low albumin/low weight
*7-18% mortal
Bulimia Nervosa
- Binging and compensatory
- clinical S/Sx
Dx Criteria
- Recurrent binging and inappropriate compensatory behavior
- twice (once in V) per week for 3 months
- Body image distortion and self worth dependent on body image
BN severity
Mild 1-3 episodes of compensation
Moderate 4-7
Severe 8-13
Extreme 14+
BN SSx
- Swollen parotid, MCP caluses (russels sign), Dental erosions and caries
- fluid and electrolyte imbalance
- GERD, Carices, melanosis coli
- CV arrhythmias and myopathies
- ENDO: menstrual abnormalitiees
- Neuro: neuropathy, fatigue, cognative slowing, seizure
BN labs
*Vomting and diuretic:
Metabolic alkylosis: lowK, low NA,high bicarb
Hypochloremic
*Laxatives:
Hyperchloremic metabolic acidosis: Low K, high Cl, Low bicarb
Low Mg, ^serum amylase
BN Epidemiology
1-3% of population
Late adolescence early adulthood
*genetic predisposition - associated with mood and impulse disorders
*more responsive to serotonin changes
BN Psychological and social
Overachiever, secretive, ego-dystonic, self critical, outgoing, angry, impulsive
*associated with depression, substance abuse, PDs, emotional lability, anxiety, dissociative disorders, abuse history
*media influence, anti-obesity education, weight teasing,
family conflict:les close, control issues, neglect/rejection
BN Tx
Same as AN but also fluoxetine
NOT BUPROPRION- lowers seizure threshold.
Prognosis: Great as long as no substance abuse
Untreated remains chronic
BED
3-5% population
- recurrent binging with distress
- 1X per week>3 months (1-3 mild, 4-7 moderate, 8-13 severe, 14+ extreme)
Avoidant/restrictive food intake disorder
- Fails to meet nutritional needs
- no body image distortion
- Not AN or BN
Obesity
BMI >30
2/3 overweight or obese, 1/3 obese
Orlistat
Lipase inhibitor for obesity
5-10 lbd weight loss in 6 months
Phentermine
Sympathomimetic decreases appetite
Lorcasein HCL
Belviq
BMI>30 or >27 with co morbid condition
Reasonable weight loss
Adults:
1-2 lbs/ week or 10% weight loss over 6 months
cut calories 500-1000 calories per day
Kids:
slow weight gain by exercising to fall back on curve
if obese: maintain for 3 months then 1lb/mo weightloss
Exercise recommendations
150 mins moderate aerobic weekly
2+ days muscle strengthening
PD Tx
Schizotypal, paranoid, and borderline PD benefit from 1/10 dose of antipsychotics
