Exam 3 Flashcards
1
Q
Assessment of Anorexia
A
- Refusal to maintain minimal normal body weight
- Intensely afraid of gaining weight
- Significant disturbance in perception of the shape or size of body
2
Q
Features Anorexia
A
- Anorexia is an innacurate term because loss of appetite is rare
- Onset in adolescence (12-18), range from pre-puberty to early 30s (rare)
- Prevalence in young females is 0.4%, much lower for older females and males
- 90% females; 10% male –> 50% are homosexual
- Mostly in whites and higher social classes
- Incidence increased signficantly from 1935-1999
- Highly comorbid with depression and perfectionism
- Excessive dieting, exercise, laxatives, diuretics, some binge eat, some vomit
- Delayed psychosexual development; absence of menstruation
- Most deny illness and are uninterested in therapy
- Most remit within 5 years, 50% relapse after treatment
- Highest mortality rate of all mental disorders (10-15%) (50% from suicide, 50% from starvation or electrolyte imbalance)
3
Q
Mortality Causes for Anorexia
A
- Suicide
- Starvation
- Electrolyte imbalance
4
Q
Causes for Anorexia
A
- Genetic
- Neurobiological
- Cultural Norms
- Desire for thinness due to gender, employment, family norms, and personality traits
5
Q
Anorexia Genetics
A
- Significant heritability
- When animals are restricted to one meal a day and provided a wheel, they exercise extensively
- Historically, when food rations declined, humans adapted to portions until more was accessible
6
Q
Neurobiological Causes of Anorexia
A
- Possible low levels of endogenous opioids cause resistance
- Zinc deficiency can create loss of appetite and depression
7
Q
What are the cultural norms of anorexia?
A
- Obesity is ideal in most developing countries (Indicates fertility)
- Female obesity considered ideal in Western societies until 1900s. Changed with industrialized economy (Similarly how tans became popularized, and how royal colours were fashionable historically)
- Difficult to avoid obesity with very tasty high caloric foods
8
Q
Anorexia is higher in?
A
- Women because of societal standards
- Dancers, models, actresses, athletes, because of professional need to be slim
- Families that place high importance on weight, physical attractiveness
- People with perfectionistic OC traits
9
Q
When does the onset occur?
Anorexia
A
Following a stressful incident
e.g., leaving home for college
10
Q
Anorexia treatment
A
- Treatment resistance
- Hospitalization until reached 85% body weight (Behaviour modification - hospital privileges until food consumption)
- Longterm psychotherapy (CBT useful for some)
- Family therapy
- No medications really effective
11
Q
Bulimia Assessment
A
- Binge eating
- Innapropriate compensatory methods to prevent weight gain
- Self-evaluation unduly influenced by body weight and shape
12
Q
Bulimia Features
A
- Increased after 1950s
- 1-2% teens and young females; 1/10 for males, high rates of homosexuality in bulimic males
- Bingeing foods are usually ‘junk foods’ with high calories
- Bulimics normal or slightly under or overweight
- Self-induced vomiting common (generally after bingeing). This is called purging
-Lifetime rates of mood, anxiety, and drug abuse disorders
Usually intermittently chronic
13
Q
Consequences of Bulimia
A
- Dental erosion
- Swollen infected salivary glands
- Esophagus perforations
- Sore throats
- Muscle weakness and cramps from loss of potassium
- Problems with digestive organs (nausea, cramps, ulcers, colitis, fatal rupturing of stomach)
- Heart problems (electrolyte imbalance and dehydration can cause cardiac arrhythmias and sudden death)
- Liver and kidney damage
- Diabetes
14
Q
Causes of Bulimia
A
- Genetic inheritance
- Neurobiological
- Cultural Norms
- Desire for thinness exacerbated by gender and personal history
15
Q
What is the cultural norm?
Bulimia
A
Desire to be thin in current Western society
16
Q
Bulimia is somewhat higher in _____
ACE
A
History of sexual abuse
17
Q
Onset of Bulimia
A
- A negative mood prior to bingeing
- Symptoms tend to increase in fall and winter, when people need to gain weight
18
Q
Bulimia Treatment
A
- Fairly Treatable
- Cognitive restructuring for unrealistic self-defeating cognitions (negative mindsets)
- Lifestyle changes to replace vomiting as a means of weight reduction
- Education and supportive counselling
- Behaviour moficiation programs
- Desensitization with response prevention
- SSRIs
19
Q
What are some lifestyle changes
Bulimia
A
- Eating behaviour
- Reduce carbs
- Increase exercise
20
Q
What is a Behaviour Modification Program?
A
A program that rewards positive behaviour
21
Q
Assessment Gender Dysphoria
A
- Strong/ persistent identification with opposite gender
- Strong/ persistent discomfort with current gender
- Previously known as ‘Gender Identity Disorder’
- Homosexuality distinguishable from Gender dysphoria (Homsexuals comfortable with their gender)
22
Q
Gender Dysphoria Features
A
- Historically rare (less than 0.01%) but increased in recent years
- Children with gender dysphoria persist into adolescense. If so, gender dysphoria is permanent
- Transgender adults almost all had gender dysphoria when they were younger
- Historically 2-5x more common for bio boys having female identity, but ratio now reversed
- Girls = tomboy Boys = feminine. Dressing as opposite gender is common
- Females wanting to be males prefer females; 50% of males wanting to be females are attracted to males
- Anxiety and depression
23
Q
____ Normative in several cultures
A
3
24
Q
Samoa
Gender
A
Fa-afafine
25
Q
N.A. Indigenous Societies
Gender
A
Two-Spirit
26
Q
Causes of Gender Dysphoria
A
- Genetic
- Neurobiological
- Environmental
27
Q
Genetics
Gender Dysphoria
A
- Twin studies show significant heritability
- Sex chromosome abnormalities sometimes present
- Boys with gender dysphoria more commonly have older brothers (competition)
28
Q
Neurobiological Causes
Gender Dysphoria
A
- Prenatal androgen exposure, hormonal problems due to drug use, stress or immunological complications during pregnancy
- Brains of boys with GD tend to resemble that of female, especially in Hypothalamus (associated with sexual orientation)
29
Q
Environmental Causes
Gender Dysphoria
A
Genetic and neurobiological causes are likely the primary, but parenting can influence gender expression (but not gender identity)
30
Q
Gender Dysphoria Treatment
A
- Hormone therapy
- Sexual reassignment surgery
- Behavioural (conversion therapy banned in many jurisdictions
31
Q
Paraphilias Assessment
A
Unusual imagery or acts necessary for sexual excitement
32
Q
Types of Paraphilias
A
- Fetishes (arousal to objects)
- Transvestite (arousal when dressing as opposite sex)
- Zoophilia (arousal with animals)
- Exhibitionism (arousal from exposing oneself)
- Voyeur (Peeping tom
- Masochism (arousal from receving pain)
- Sadism (arousal when administering pain)
- Frotteurism (arousal from rubbing up against other people)
- Pedophilia (arousal to prepubescent children)
33
Q
Paraphilia Features
A
- Typically males
- Typically chronic
- Most have 1+ paraphilia
- Unknown prevalence but not uncommon
34
Q
Causes of Paraphilias
A
- Genetic/ Evolutionary
- Associative Learning
35
Q
Treatment of Paraphilias
A
- Difficult to treat (association has been reinforced)
- Orgasmic reorientation
- Psychotherapy not effective
- Medication
36
Q
What medications can treat paraphilias
A
- Antiandrogens
- SSRIs
37
Q
Psychotherapy is ____
Paraphilias
A
Ineffective for paraphilia treatment
38
Q
Addiction Assessment
A
- Difficulty controlling involvement in pleasurable activity causing significant problems
- OCD no pleasure derived from compulsions
- Dependence (synonymous)
- Substance use disorder (mild, moderate, and severe)
39
Q
Elements of Addiction Assessment
A
- Personal Interview
- Standardized Psychometric Tests
- Third Party Report (Spouse, employer)
- Biochemical Testing (urine analysis, breathalyzer)
40
Q
Features of Addiction
Types of Addictions
A
- Drugs (~25%; 60% male) - Most common addiction in Canada and every country
- Work (~10%; most male)
- Eating/ Food (~7%; 70% female)
- Shopping (~4%; 85% female)
- Social Media (~3%; equal ratio)
- Sex/ Pornography (~2%; 65% male)
- Gambling (~1%; 65% male)
- Exercise (~1%; equal sex ratio)
40
Q
DSM-5 Criteria
Addiction
A
- Substance taken in large amounts over long period of time
- Persistent desire or unsuccessful effort to control use
- Great deal of time spent to obtain susbtance, using, or recovering from effects
- Cravings
- Reccurent use in failure to fulfill major role obligations at work, school, or home
- Continued use despite associated problems
- Important socia, occupational, recreational activities given up because of recurrent use
- Recurrent use in physically hazardous situations
- Use continued despite knowledge of having persistent or reccurrent physical or psychological problem caused by susbtance
- Tolerance define by (a. Need for increased amounts of intoxication to achieve effect, b. Diminished effect with continued use of the same amount)
- Withdrawal as manifest (a. Characteristic withdrawal syndrome, b. substance taken to relieve withdrawal)
41
Q
Features of Addiction
Facts
A
- Addictions most common mental disorder worldwide
- Drug addictions in Canada result in ~70,000 deaths per year (Primarily from tobacco, alcohol, opioids, and benzodiazepines)
- Major contributor to health care costs, crime, and family violence and disruption
- Highest rates in 18-30 yr olds
- High co-occurence with other addictions
- High co-occurence with depression
- Episodically chronic (Many recoveries and many relapses, you remain at risk for relapse your entire life)
42
Q
Problem Behaviours in Addiction
A
- Addictive behaviour
- Substance use
- Mental health problems
- Interpersonal problems
- Poor health practices
- School/ Work problems
- Antisocial Behaviour
- Addictive Behaviour
43
Q
Main Drugs of Abuse Worldwide
A
- Alcohol
- Tobacco
- Cannabis
- Opiates/ Opioids
- Ecstasy (MDMA)
- Cocaine
- Amphetamines
- Benzodiazepines
(Variation between countries)
44
Q
Main problematic forms of gambling worldwide
Features
A
- Electronic Gambling Machines (slots, VLTs)
- Casino Table Games (Blackjack, baccarat, roulette)
- Online Gambling
