Abnormal Psych. Exam 3 Flashcards
Bulimia Nervosa
Characterized by recurrent episodes of uncontrolled excessive eating followed by compensatory actions to remove the food
ecurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (Ex: vomiting, laxative abuse, and escessive exercises)
Anorexia nervosa
Characterized by recurrfent food refusal, leading to dangerously low body weight
recurrent food refusal, leading to dangerously low body weight
Binge Eating disorder
Pattern of eating involving very rapid, distress-inducing consumption of large amounts of food that are not followed by purging behaviors
pattern of eating involving distress-inducing binges not followed by purging behaviors
Criteria for Bulimia Nervosa
-Recurrent episodes of eating, in a discrete period of time an amount of food that is definetly larger than most people would eat during a similar period of time under similar circumstances AND a sense of lack of control over eating during the episode
-Recurrent inappropriate compensatory behaviors in order to prevent weight gain (ex: self-induced vomiting, misuse of laxatives, diuretics, other medications, fasting, or excessive exercise)
-Binge eating and inappropriate compensatory behaviors both occur on average once a week for 3 months
-Self-evaluation is unduly influenced by body shape and weight
-The disturbance does not occur exclusively during episodes of anorexia nervosa
Criteria for Anorexia Nervosa
-Restriction of energy intake relative to requirements, leading to a significantly low body weight (by age, sex, developmental trajectory, physical health)
-Intense fear of gaininig weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
-Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape of self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Significantly low weight
weight that is less than minimally normal or, for children and adolescents, less than that minimally expected
Two subtypes of Anorexia
Restricting and Binge-eating/purge type
Restricting type of Anorexia Nervose Criteria
-During the past 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
-Weightloss is accomplished primarily through dieting, fasting, and/or excessive exercise
Binge-eating/purging type of Anorexia Nervosa Criteria
-During the past 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating Criteria
-Recurrent episodes of eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances AND a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)
-Episodes are associated with at least 3 of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or very guilty afterward
-Marked distres regarding binge eating being present
-The binge eating occurs, on average, at least once a week for 3 months
-The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
Bingeing
-hallmark of bulimia nervosa and binge eating disorder
-Eating excess amounts of food in a discrete period of time
-Eating is perceived as uncontrollable
-May be associated with guilt, shame, or regret or particularly stressful times
-May hide behavior from family members
-Foods consumed are often high in sugar, fat, or carbohydrates
Examples of Purging
vomiting, laxatives, diuretics
Causes of Eating Disorders: Social Dimensions
-Societal emphasis on thinness -> Prioritization of being perceived as thin over being healthy -> Dieting
-Glorificatiton of slenderness
-Close Friendships group sharing similar attitudes concerining body image, dietary restraint, and extreme weight-loss behaviors
-Settings where social pressures are exceptionally intense for being thin, such as ballet schools or among athletes or gymnasts
-Failure to thrive syndrome
-Dieting in an early age is linked to an increased risk of future dietary attempts and developing eating disorders (dietary attempts in adolescent girls result in weight gain, stress, and heightened preoccupation with food & eating during the dieting
Glorification of slenderness
the extent to which women internalize media messages glorifying thinness increseases the risk of developing eating disorders
-Gender differences in body image perceptions
Failure to thrive syndrome
Toddlers does not gain weight at the expected rate
Parents put their toddlers on diets in the hope of preventing obesity
Causes of Eating Disorders
Family interaction before eating disorders
-Success orientation, ambition, perfectionism, concern for external appearances, desire to maintain harmony
-Not the primary causes of eating disorders
Family dynamics after eating disorder can quickly deteriorate
-Physical punishment from parents is linked with poorer outcomes for the eating disorder
Reverse Anorexia Nervosa
men reported concern about looking small, even though they were muscular
-prone to steroids
Causes of Eating disorders: Biological Dimension
Inherited vulnerability
-unstable or excessive neurobiological response to stress associated with impulsive eating
Genetic influence
-Response emotionally to stressful events, impulsive eating, perfectionism, negative affect
Hypothalmus -> regulating eating
Reduced Serotonin activity-> impulsivity & binge eating
Ovarian hormones-> Hormone-responsive genes
-Speculate onset of puberty & hormonal changes may “turn on” certain risk genes
-Emotional or binge eating peaked in postovulatory phase (menstrual)
Causes of Eating Disorders: Psychological Dimension
-Anxiety focused on appearance
-Distorted body image
-Diminished self-confidence
-Low self-esteem
-High perfectionism
-Imposter Syndrome
-Distortions in the perception of body image
-Mood intolerance
Imposter syndrome
-Perceive self as a fraud
-False any impressions made of being adequate self-sufficient, or worthwhile
-Heightened levels of social anxiety
Mood intolerance
extreme regulation tactics for mood
Treatment of Bulimia Nervosa
-Psychoeducation about the physical effects of binge eating and purging, the inefficacy of vomiting and laxative abuse for weight control
-Discussing the adverse effects of dieting
Behavioral component
-Adopting a structured eating schedule, consuming small, manageable portions five or six times daily with no more than a 3-hour interval between any planned meals and snacks
-introducing forbidden foods into diet
-organizing activities to avoid solitary time
Cognitive Component
-coping strategies
-Monitoring and confronting the cognitions that accompany the binge episodes and purging episodes. Then the therapist helps the client confront these cognitions and develop more adaptive attitudes toward weight and body shape. Afvter meals in the initial stagees of treatment is also an important aspect of the treatment
-Cognitive-behavioral therapy-enhances (CBT-E) -> Interpersonal therapy & Psychoanalytic psychotherapy
-Family therapy has also proven effective
Cognitive-behavioral therapy-enhances (CBT-E)
-Treatment of choice
-Principal focus is on the distorted evaluation of body shape and weight and on maladaptive attempts to control weight in the form of strict dieting and compensatory activities
Treatment of Binge Eating Disorder
-Previously used medications for obesity are now not recommended
Psychological treatment
-CBT (effective)
-Interpersonal psychotherapy (equally effective as CBT)
-Self-help techniques (effective)
Treatment of Anorexia
-Initial treatment goal is attaining a weight in the healthy range
Psychoeducation
-Behavioral and cognitive interventions
-target food, weight, body image, thought, and emotion
-Treatment often involves the family
-Has the most support from clinical trials for treating adolescents with anorexia
Night eating disorder
-Consume 1/3+ of daily calories after dinner
-Get out of bed at least once during the night for a high-calorie snack
-Often not hungry the next morning and skip breakfast
Bariatric surgery
stapling the stomach to create a small pouch or bypassing the stomach through gastric bypass surgey
-popular approach for BMI > equal to 40
-health risk due to permanent
Social Jetlag
repeated switching of a daily scedule because of social factors, similar to changing time zones when traveling
Stages of sleep
Non-Rapid Eye Movement (NREM) sleep: 3 stages
1- brain waves slowing down
2-shallow
3-deep sleep
Rapid Eye Movement (REM) sleep: muscles become atonic but nitense mental activity can be observed
Chronotype
the tendency for the body to prefer the morning or eveninig, regulated by body’s circadian clock, genetic variations in the clock genes, and the environment
Polysomnographic (PSG) evaluation of sleep
-clear & comprehensive of sleep habits
-overnight patient moniored on a number of measures
-detailed history, assessment of sleep hygiene and sleep efficacy
Polysomnographic (PSG) evaluation of sleep: Electroencephalograph (EEG)
brain waves
Polysomnographic (PSG) evaluation of sleep: Electrooculograph (EOG)
eye movements
Polysomnographic (PSG) evaluation of sleep: Electromyography (EMG)
muscle movements
Actigraph
wearable device sensitive to movement
-can detect different stages of wakefulness/sleep
-length & quality of sleep
Dyssomnias
Difficulties in amount, quality, or timing of sleep
Ex: still feeling tired
Parasomnias
Abnoraml behavioral and physiological events during sleep
Ex: nightmares & sleepwalking
Parasomnia Criteria
-Recurrent episodes of incomplete awakening from sleep usually occurring during the first third of the major sleep episode, accompanied by either one of the following: sleepwalking or sleep terrors
-No or little dream imagery is recalled
-Amnesia for the episodes is present
-The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
-The disturbance is not atttributable to the physiological effects of a substance (e.g., a drug abuse, a medication)
-Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors
Sleepwalking
-Repeated episodes of rising from bed during sleep and walking about
-While sleepwalking, the person has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty
Sleep terrors
-Recurrent episodes of abrupt terror arousals from sleep, usually beginning with panicky scream
-Intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode
-Relative responsiveness to efforts of others to comfort the individual during the episodes
Insomnia
-Characterized by difficulty initiating or maintaining sleep
-one of the most common sleep disorders
-problems initiating/maintaining sleep (e.g. trouble falling asleep, waking during the night, waking too early in the morning)
-Only diagnosed as a sleep diroder if it is not better explained by a different condition like anxiety (primary insomnia)
Microsleeps
short, seconds-long periods of sleep that occur in people who have been deprived of sleep
Rebound insomnia
sleep problems reappear; worsened sleep problems can occur when medications are used to treat insomnia and then withdrawn
Hypersomnolence disorder
-a disorder involving excessive amount of sleep that disrupts normal routines
-characterized by sleeping too much
-experience excessive sleepiness as a problem
-often associated with other medical and/or psychological conditions such as depression
Sleep apnea
brief periods when breathing ceases during sleep
-snore loudly, pause between breathes, dry mouth & headache
Narcolepsy
-A disorder characterized by sudden and irresistible sleep attack
-Recurrent intense need for sleep, lapses into sleep, or napping
-Accompanied by one of the following: Cataplexy, Hypocretin deficiency, Going into Rem sleep abonormally fast
-Rare condition
—-Suggested to be associated with cluster of genes on Chromosome 6 and may be an autosomal recessive trait
—Appears a significant loss of a certain nerve cell (hypocretin neurons) in those with narcolepsy
Sleep paralysis
brief period after awakening when they can’t move or speak that is often frightening
Hypnagogic Hallucinations
vivid & often terrifying experiences that begin at start of sleep and seem realistic due to multiple sensations
Hyperventilation
constricted and labored breathing
Breathing related disorders:
-Obstructuve sleep apnea hypopnea
-Central sleep apnea (CSA)
-Sleep-related hypoventilation
Obstructuve sleep apnea hypopnea
-Airflow stops, but respiratory system works
-Associated with age and obesity
-Occurs in 10 to 20% of population
-More common in males
Central sleep apnea (CSA)
-repiratory systems stops for brief periods
-often associated with certain CNS disorders
-no daytime sleepiness reports, unaware
Sleep-related hypoventilation
Decreased breathing during sleep not better explained by another sleep disorder with a complete pause in breathing
-Cause increase in CO2 levels, insufficient air exchange
Circadian Rhythm
Disturbed sleep leading to distress and/or functional impairment
-Affects supriachiasmatic nucleus, which stimulates melatonin and regulates sense of night and day
Types:
-shfit work type
-familial type
-delayed or advanced sleep phase type
-irregular slep-wake type
-Non-24 hour sleep-wake type
Circadian Rhythm: Shift work type
job leads to irregular hours
Circadian Rhythm: Familial type
associated with family history of dysregulated rhythms
Circadian Rhythm: Delayed or advanced sleep phase type
person’s biological clock is naturally “set” earlier or later than a normal bedtime
Circadian Rhythm: Irregular sleep-wake type
people who experience highly varied sleep cycles
Circadian Rhythm: Non-24 hour sleep-wake type
sleeping on a 25-26 hour cycle with later and later bedtimes, ultimately going throughout the day
Parasomnias: Non-REM Sleep Arousal Disorders
=characterized by abnormal events that transpire eitherduring sleep or the transitional phase between sleeping and waking
Non-rapid eye movement sleep arousal disorders
incomplete awakening and either sleepwalking or sleep terrors and recurrent episodes of screaming or other signs of great fear
Nightmare disorder
frequent awakening by terrifying dreams
Rapid eye movement sleep behavior disorder
involves arousal during sleep associated with vocalization or complex motor behaviors
Restless legs syndrome
involves an urge to move the legs that disturbs sleep
Substance/medication-induced sleep disorder
involves severe sleep disturbances apparently caused by intoxication or medication
Circadian rhythm sleep-wake disorder
a disorder that occurs as a result of a mismatch between the resting schedule a person requires to function at their best and the schedule imposed by the environment
Obstructive sleep apnea
a disorder associated with snoring, snorting/gasping or breathing pauses during sleep and daytime sleepiness that occurs as a result of blockages in the upper respiratory system
Parasomnia Treatment
-Research on treatment of nightmares suggests that both psychological intervention (such as cognitive-behavioral therapy) and pharmacological treatment (such as prazosin) can help reduce these unpleasant sleep events
-One approach to reducing chronic sleep terrors is the use of scheduled awakenings