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exam 3 Flashcards

1
Q

DSM 5 Major Depressive Disorder

A

5 or more symptoms during 2 week period, represent change from previous functioning, at least one symptom must be depressed mood or loss of interest/pleasure
-depressed mood every day (irritability in children)
-anhedonia
-weight loss or weight gain
-insomnia/hypersomnia
-psychomotor changes
-fatigue
-feelings of worthlessness/guilt
-impaired concentration/decision making
-recurrent thoughts of death

symptoms clinically significant, not attributable to drugs or medical condition, not better explained by schizophrenia, no manic/hypomanic eps

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2
Q

case study: 12 year old with depression

A

suicide attempt with antidepressants and tylenol
precipitated by argument with father over chores/grades
felt worthless/hopeless 2 months
lost weight, isolated self, grades fell

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3
Q

case study: 15 year old with depression

A

irritable, fighting with mom
teased by peers
didn’t like school, refused to go, stayed in bed
constantly tired but couldnt sleep

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4
Q

PERSISTENT DEPRESSIVE DISORDER dsm

A

depressed/irritable mood most of day most days, in children must be present at least 1 year
at least 2:
poor appetite or overeating
insomnia/hypersomnia
low energy/fatigue
low self-esteem
poor concentration/decision making
feelings of hopelessness
during year peroid of disturbance, the individual has never been without the symptoms in a and b for more than 2 months
criteria for major depressive disorder may be continuously present
no mania/hypomania
no schizophrenia
no drugs/medical issues
clinically significant

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5
Q

DEPRESSION PREVALENCE

A

under twelve: .4 to 2.5%
over twelve: 4.8 to 8%
by age 19, 15-28% exp MDD

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6
Q

DEPRESSION GENDER DIFFERENCES

A

age 6-11: equal
13-15: more girls than boys
15-18: girls dramatically higher 2-3: 1

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7
Q

DEPRESSION CO OCCURING DISORDERS

A

40-70% of children with mdd have 1+ disorders
-anxiety, adhd, disruptive disorders, substance us, eating disorders
-dimensional impairment: children with sublinical symptoms often show significant impairment

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8
Q

developmental course of depressive disorders

A

age of onset: 14-15
median duration of MDD: 8 months
median duration of PDD: 48 months
earlier age of onset=more sever/significant impairment
aprrox. 90% recover within 1-2 years; 70% relapse

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9
Q

depressive disorders episodic nature

A

MDD episodes sensitizes brain to be more reactive to stressors, primes for relapse
clients should be educations about the signs of relapse

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10
Q

age differences in depressive phenomenology

A

early childhood: kids can’t communicate internal stats. key is looking for changes in child’s normal functioning that are paramount
-not specific symptoms for depression
school age: depressed mood, irritable mood, academic issues, issues with peers
adolescents: adult-like symptoms emerge

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11
Q

depressive disorders etiology heritibility

A

.3-.4 heritability estimate
-risk for depression increases risk to environmental stressors
-environmental stress moderates effects of specific gene variants
-short serotonin transporter gene (risky allele) increases depression but so does stress

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12
Q

DEPRESSIVE DISORDER ETIOLOGY: endophenotypes

A

-dysregulation of HPA axis - dysregulation of stress response (basal and reactive levels of cortisol)
Children: mixed findings- clearest among teens with severe MDD
STRUCTURAL AND FUNCTIONAL BRAIN ABNORMALITIES
structural: smaller brain volume in PFC and amygdala
functional: abnormally high activation in the amygdala and other regions involved in emotion processing regulation
depressed children showed higher levels of activation in right amygdala and right thalamus

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13
Q

DEPRESSIVE DISORDERS ETIOLOGY: COGNITIVE RISK FACTORS

A

depressogenic cognitions
-present in depressed youth, can be elicted by stressful events and predict later adjustment
-precedes onset of symptoms
-negative thoughts about self, world future (negative triad)
-rumination and co-rumination: coping style strongly associated with depression (co-rumination means ruminating with peers/close others which exacerbates)

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14
Q

negative triad case study

A

14 year old girl sees herself as a social loser constantly worreid that friends were rejecting her
best friend agreed to go see movie but ended up unable to make it
long history of negative views of relationship; girl freaked out
withdraw from friends creates social world in ways that are depressing

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15
Q

DEPRESSIVE DISORDER ETIOLOGY: interpersonal factors

A

parent-child relationships
-children of depressed parents at high risk for a broad range of problems including depression
–probably reflects parents impaired response to kids

peer relationships
-difficulties contribute to depression
depressed children and youth see themselves as socially incompetent, show distortions in information processing
co rumination

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16
Q

DEPRESSIVE DISORDERS TREATMENT

A

INPATIENT
-severe depression and suicidal behavior
DRUG TREATMENT
-fluoxetine (prozac) , SSRIs
CBT
-self monitor and challenge cognitive and behavioral symptoms
improve social skills and social support
parent component
COMBINED TREATMENT
best
psychoeducational treatment for parents
monitored drugs and cbt

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17
Q

Depressive Disorder Case Study ANNA

A

suicide attempt following depressive symptoms new school, black in white area, severe family stress, kids made fun of her weight, skipped school, felt lonely, sad, guilty about divorce, hopeless, tired and unmotivated

inpatient ward, meds, therpay, cbt, weight loss, social skills, good outcomes

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18
Q

BIPOLAR SPECTRUM DISORDERS: CHILDREN AND ADOLESCENTS

A

considered adult disorder until the 90s
medication is strong and potentially dangerous for kids
overdiagnosis of pediatric cases
concern about potentially toxic treatments

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19
Q

DSM 5 DISRUPTIVE MOOD TEMPER DYSTREGULATION DISORDER

A

DO NOT DIAGNOSES BEFORE AGE 6 OR AFTER AGE 18
severe temper outbursts manifested verbally or behaviorally that are grossly out of proportion in intensity or duration to situation of provocation
temper outbursts are inconsistent with developmental level
on average 3x a week
mood is generally irritable
symptoms present for at least 12 months, no period without all symptoms for 3+ months
symptoms present in 2 of 3 settings: home, school, peers and are severe in at least one
age of onset before age 10
no distinct hypomanic or manic period
behavior not better explained by mdd or another disorder, cannot coexist with odd, bp, intermittent explosive disorder
not attributable to effects of substances or medical illness

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20
Q

case study DMDD

A

mood swing, irritable infant, irregular sleep cycles, igh levels of irritability and temper tantrums in preschool, aggrressively lashing out, tried to ru out in a busy street, separation anxiety, behaviors frightened teachers and peers, couldn’t stay in nomral classroom

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21
Q

BIPOLAR DISORDER DSM

A

MANIC EPISODE
-persistent elevated, expansive mood at least 1 week every day.
during period of mood disturbance, 3+ are present (4 if mood only irritable) and represent change from usual behavior:
-inflated self esteem
-decreased need for sleep
-excessively talkative
-impared concentration/decision making
-feeling of thoughts racing
-psychomotor agitation
-excessive pleasure seking

mood disturbance is sufficiently severe to cause marked impairment or necessitate hospitalization to prevent self-harm

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22
Q

bipolar disorder gender differences

A

RARE DISORDER: lifetime prevalence 0.6%
slight male preponderance: 1.1: 1
cultural differences need further study
more common in high-income than low-income countries

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23
Q

bipolar case example: jessica, 5

A

talked about wanting to cut off parents heads, grandiose thoughts, clear 2-3 weeks of depression, diagnosed with BPA1. at 12 there’s a mean girl at school and dad was deployed, jessica says she cries and screams a lot

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24
Q

bipolar disorder cooccuring disorders

A

present in most cases:
adhd, anxiety disorders, odd/cd, SUDs, suicidal behaviors
in children, confusion with ADHD
in adolescents, confusion with schizophrenia
how to tell apart:
adhd and schizophrenia are not sudden, manic episodes are
broad spectrum of impairment; impairment still occurs in subclinical levels

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25
Q

bipolar disorder onset, course, prognosis

A

peak age of onset 15-19 years
course: episodic/recurring
BP in preschoolers may be diagnosed but onset prior to age 10 is extremely rare
earlier age of onset <15 predicts more severe and chronic impairment
can prodromal phases be identified?
–disruptive mood disorder may be a prodromal phase
–spontaneous suicidal ideation: preschoolers later dx with BP
——what do you want for xmas? a gun so i can kill myself
——began talking at age 3 that he did not deserve to live on earth and attempted suicide at age 7

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26
Q

bipolar disorder etiology

A

strong genetic component: 80% heritibility
offspring of parents with BP: 52% met criteria for some diagnosis; 26% for an affective disorder, 5.4% BP

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27
Q

treatment of bipolar disorder

A

pharmacological (lithium, mood stabilizers)
education of patient and family
monitoring family and child over time

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28
Q

what is an anxiety disorder

A

tripartite model: physiological arousal, cognitions (perception of threat to self schema), behaviors (fight/flight) —- concerns about future events

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29
Q

fear vs phobia vs panic

A

fear- typical fears - threatens our immediate safety

phobia- fear/avoidance cycles - “out of proportion” fear of object or situation - many are developmentally appropriate and decline with age

panic - overwhelming anxxiety that is incapacitating

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30
Q

normal fear vs anxiety disorders

A

clinical concern for issues that are chronic and disabling
assessment challenge: age-related ability to verbalize anxious feelings
chronicity, degree of distress, functional impairment

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31
Q

how distinct are different anxiety disorders

A

high levels of comorbidity; few studies have shown discriminant validity of childhood anxiety disorders

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32
Q

SEPARATION ANXIETY DISORDER dsm

A

age inappropriate, excessive anxeity/fear concerning separation from those to whom the individual is attached. 3 must occur persistently and excessively at impairing levels:
-distress when anticipating or experiencing separation from home or caregivers
-worry about losing major caregivers/possible harm to them
-worry about experiencing untoward event that causes separation from caregivers
-fear of being alone or without major attachment figures
-refusal to sleep away from home/away from major caregiver
-repeated nightmares involving separation
-complaints of physical symptoms when separation occurs or is anticipated to occur from major attachment figures

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33
Q

SEPARATION ANXIETY DISORDER prevalence

A

one of the two most common anxiety disorders of children <12
4% 6-12 month prevalence

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34
Q

separation anxiety disorder gender differences

A

girls > boys in community, g=b in clinical setting

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35
Q

separation anxiety age of onset

A

around 7 is average, usually follows a disruptive event: divorce, moving, death

36
Q

developmental course of separation anxiety

A

typical progression of symptoms
50% develop another disorder after sad (often depression)
persistence into adulthood about 1/3

37
Q

SEPARATION ANXIETY DISORDER case study kenny

A

Kenny, age 10, extremely fearful, refused to go to school. unable to be separated from parents, couldn’t play in the backyard, couldnt’ go to little league, etc. threatened to hurt himself when forced to go to school. high levels of anxiety, specific fears, and depressive symptoms, started a year ago when his father developed drinking problems

38
Q

GENERALIZED ANXIETY DISORDER dsm5

A

excessive anxiety or worry occuring more days than not for at least 6 months, about a number of events or activities
the individual finds it difficult to control the worry
for children, anxiety and worry are associated with 1+ of the following symptoms present most days for the past 6 months
-restlessness or feeling keyed up or on edge
-being easily fatigued
-difficulty concentration or mind going blank
-irritability
-muscle tension
-sleep disturbances

39
Q

GAD clinical features

A

episodic or continuous
concomitant somatic complaints (headaches, stomachaches, muscle tension)
what if thoughts; self-doubts; perfectoinism; worry about worry
roughly 40% of children referred for ADs have GAD (but only 2.2% in community samples)

40
Q

GAD case study: Lindsey

A

8 years old
first panic attack after watching a scary movie, thought she was having a heart attack. wakes up a lot in middle of night, wouldn’t eat popcorn because she thought it would kill her, she’s afraid to swim bc she thinks she’ll have a panic attack underwater, runs home bc afraid of being kidnapped. got therapy

41
Q

SOCIAL ANXIETY DISORDER dsm 5

A

marked fear or anxiety about one or more social situations in which the individual es exposed to possible scrutiny by others (peer settings)
fears about acting in a way that shows anxiety symptoms that will be negatively evaluated
social situations almost always provoke fear or anxiety
social situations are avoided or endured with intense anxiety
fear/anxiety is out of proportion to the actual threat posed by situation
fear/anxiety/avoidance lasts for 6 months or longer
symptoms cause clinically significant distress and or impairment
specify if fear restricted to speaking or performing in public

42
Q

social anxiety disorder CLINICAL FEATURES

A

CONTINUUM OF severity
prevalence: 6-12%
age of onset: mid adolescence
gender diff: 2:1 g>b

43
Q

social anxiety disorder developmental course

A

fears of social evaluation and demands for social interaction in transition into adolescence
earlier age of onset and generalized predicts more chronic course
soc anxiety is highly treatable

44
Q

selective mutism vs social anxiety disorder

A

selective mutism: failure to speak in specific situations, present at least 1 month, not better explained by communication disorder
prevalence of mutism: rare, less than 1%
no diff between boys and girls
age of onset 3-4 years
co-occurring disorders: anxiety

45
Q

WHAT CAUSES ANXIETY DISORDERS

A

runs in the family
40% heritability moderated by age, gets higher for girls
what is inherited (endophenotypes):
-behavioral inhibition: inhibited children more likely to meet criteria for anxiety disorders in later life
–most probable outcome: normal development
risk factor for anxiety disorder

46
Q

brain differences in anxiety disorders

A

amygdala, ventrolateral cortex and neurotransmitter systems gaba, serotonin

47
Q

psychosocial protective factors

A

sensitive parenting and family support
rhesus monkeys with short allele do not express social anxiety when raised by responsive monkey moms
insensitive moms = more anxiety

48
Q

OCD dsm

A

presence of obsessions, compulsions, or both
obsessions: recurrent persistent thoughts, urges or images experienced as intrusive and unwanted; cause marked distress
person attempts to ignore or suppress obsessions or to neutralize with some other thought or action

compulsions: repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or to rigid rules
behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. behaviors mental acts not connected in a realistic way with dreaded event, or are excessive
–young children may not be able to articulate aims of behaviors
obsessions and compulsions are time consuming >1hr/day and cause clinicaly significant distress and/or impairment
specifiers: insight into irrationality?
tic related?

49
Q

OCD case study

A

feels nervous before compulsions, like something bad is going to happen to him or to his mom. actions have to be in groups of 3 and done just right to relieve nervousness. short-term reduction of anxiety.

50
Q

sex differences of OCD

A

sex differences: B>G 2:1 in childhood
in adolescents: B=G

51
Q

prevalence and course of OCD

A

1-2% accross the lifespan
onset pattern: 6-10, often in oys
most children with ocd also meet diagnostic criteria for other disorders: tic disorder, other ADs, depression, adhd, substance abuse, eating disorders

chronic and episodic
most children improve with treatment (3/4) but problems often persist, relapse often occurs

52
Q

WHAT CAUSES OCD

A

evidence supports neurobiological foundation
moderately heritable
brain imaging studies: dysfunctional activation of cortical-ganglionic-thalamic circuit/loop

53
Q

OCD case study, Jade

A

11 years old, worried about fire, makes sure lights are off
switches video game system on/off 60x per day
reties shoes, washing hands until bleeding
jade is suicidal, she has no control over ocd. doctor said to “just ignore it”
drugs and exposure helped significantly.

54
Q

ANXIETY DISORDER TREATMENT

A

exposure is very important
graduated exposure paired with coping responses that are incompatible with anxiety

CBT: successful in 70% of cases
-social skill bhilding, practice real life scenarios, adaptive coping skills
FAMILY THERAPY- teach family how to avoid exacerbating child’s anxiety

55
Q

anxiety disorder treatment case study: bradley (social anxiety disorder)

A

age 12. extremely stressful set of transitions. anxious, depressed, withdrawn. did poorly on oral presentation-shaking, hard time talking, kids in the class teased him, lead to bullying. treatment goals set: exposure to anxiety situations, build coping skills, work on generalizing to settnigs other than consulting room. list hierarchy of anxiety provoking situations. start with least scary, talk about it, go out in real life and practice. to promote generalization joined peer group of kids w/ social issues

56
Q

DEVELOPMENTAL ASPECTS OF STRESS AND TRAUMA

A

trauma: outside the range of usual human experience, would be distressing to anyone, life threatening
too scared to cry-landmark study to change views of PTSD. children kidnapped off school bus and put in trailer underground. none were injured by all children were symptomatic of PTSD after 5-13 months.
DSM5 disorders of stress and trauma have their own chapter

57
Q

PTSD >6 years DSM

A

exposure to actual or threatened death, serious injury, or sexual voilence
-direct or indirect experience (but not thru electronic media)
one or more intrusion symptoms associated with the traumtaic events
-recurrent, involuntary, intrusive, distressing memories of trauma (expressive play in children)
-recurrent, distressing dreams with content related to the trauma (dreams may not have recognizable content, may not be able to express what is bothering them)
-dissociative reactions– flashbacks (trauma-specific reenactment in play in children)
-intense or prolonged distress to exposure to cues that resemble the event
-marked physiological reactions to cues that resemble or symbolize the event
persistent avoidance of stimuli associated with traumatic events
negative alterations in cognition sand mood associated with the traumatic event
marked ealterations in arousal and reactivity associated with trauma
duration at least 1 month
specify- dossociative symptoms - general numbing, detachment, depersonalization. amnesia
specify- onset delayed - 6 months after event

58
Q

PTSD <6 years DSM differences

A

same intrusion symptoms
PERSISTENT AVOIDANCE OF STIMULI AND/OR NEGATIVE CHANGES IN COGNITION
-avoidance of trauma related activites, places, physical reminds
avoidance of people, conversations, or interpsonal situations that arouse memories of traumatic events
increased frequency of negative eomtional states
diminished interest or participation
changes in arousal or reactivity

59
Q

ACUTE STRESS DISORDER

A

acute stress disorder is the intermediate diagnosis given after a traumatic event but before 1 month is over to diagnose with PTSD; duration greater than 3 days but less than 1 month

60
Q

PTSD examples in child’s behavior

A

Post-traumatic play: child shot in hand plays shooting games, when playing doctor with therapist is very rough

Psychic numbing: 6 years old when her house was robbed, her mother and sister killed. the girl played dead to save her life. her grandmother says she is not afraid of anything.
Regressions: bed wetting, thumb sucking, sleeping with parents, grades fall behind, distress with separations. for same girl, she started sucking her thumb and grades have slipped

61
Q

PTSD DIAGNOSTIC ISSUES

A

chronic trauma complicates things; cumulative.
children with the longest lasting and most severe reactions had more traumatic experiences in multiple settings

subclinical symptoms: co-occurring disorders: anxiety, ODD, SAD, CD, substance abuse, depression

prevalence in children 5% in gen pop, of those exposed to a traumatic event 34%

62
Q

sex and age differences in PSTD

A

girls of all ages are at increased risk for PTSD immediately following trauma and in subsequent years. longer duration
rumination, expression, girls exp more sexual trauma

manifestations of ptsd may differ according to the age of the child. younger – the greater the likelihood their reactions depend on people around them. little cognitive understanding, so younger children blame trauma on themselves more often
greater impact on developing brain

63
Q

course and prognosis of PTSD

A

symptoms of PTSD peak in first year of traumatic event
sizable number of children and youth manifest symptoms after the first year

64
Q

Why do only 35% develop PTSD and other impairing disorders

A

-individual differences in vulnerability
-stress sensitivity
-previous exposure to trauma
-preexisting psychopathology

DOSE OF EXPOSURE MODEL: how close the child is to epicenter of traumatic event. closer, more likely they are to develop ptsd
reactions of parents and other adults

post traumatic environment
quality of family support
community and school support
loving and supportive care before and after traumatic event bufferes children from aggressive symptoms and depressions
associated with creativity and cognitive capacity, which predicts good adjustment despite trauma
strong correlate of reslience

SUBJECTIVE APPRAISAL
attribution of responsibility (egocentric thinking)
negative thoughts about self, others, future
ideological commitment (chronic, high stress living zones)

65
Q

PTSD INTERVENTIONS

A

CRISIS INTERVENTION STRATEGIES:
-psychological first aid to children exposed to disaster– get all children together, normalize stress reactions, minimize confusion, develop narratives, mitigate fear contagion

-CBT– psychoeducation, tell story, construct narrative, taught anxiety management skills, stress thermometer

community intervention: building support in schools and communities

graduated exposure to traumatic triggers

66
Q

COMPLEX TRAUMA

A

exposure to multiple traumatic events
long-term effects of exposure
usually interpersonal with caregiver

can involve abandonment or harm by caregivers or attachment figures
can occur at early stages of life and development

67
Q

abuse and neglect; developmental outcomes

A

over seven million reported cases of child abuse/neglect
physical, emotional, sexual, neglect

disruptions of early developmental tasks: forming secure attachment, developing adequate skills in emotion regulation
disrupts representational models of self/others
disruptions in brain development
-structural and functional abnormalities
-impaired HPA axis function
impaired behavioral and academic adjustment
disorders linked directly with inadequate caregiving

68
Q

Reactive Attachment Disorder DSM5

A

consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
persistent social and emotional disturbance
-minimal responsiveness to others
-persistent inability to experience positive emotions
-episodes of unexplained irritability, sadness, fearfulness during nonthreatening interactions with adult caregivers
child has experienced a pattern of extermes of insufficient care
not attributable to ASD
evident between 9 months and 5 years
specifiers: persistence, severity

69
Q

Disinhibited social engagement disoder DSM5

A

pattern of behavior in which a child actively approaches and interacts with unfamiliar adults
reduced or absent reticence in approaching unfamiliar adults
overly familiar verbal or physical behavior
diminished or absent checking back with adult caregiver after venturing away
willingness to go off with strangers
not linked to impulsivity
child has experienced patterns of insufficient care
persistent lack of having basic emotional needs for comfort stimulation and affection from caregivers
repeated changes of primary caregivers that limit opportunities to form stable attachments
rearing in unusual settings that severely limit opportunities to form selective attachments

70
Q

adult outcomes of complex trauma

A

mental health problems: ptsd, personality disorders, dissociative disorders, SUDs, depression, anxiety, eating disorders, suicidal behavior
violent behavior and criminality
revictimization: IPV, sexual assault
impaired physical health
maltreatment of own children (20-30%)

71
Q

prevention targets

A

too many root causes:
inter partner violence
economic hardship
social isolation
deviant attributional style in parents
deviant parental norms about child behavior
features of individual child’s behavior that elicit stress, anger in parents
parent histories of ACEs

72
Q

complex trauma case study: Jolene age 12

A

jolene, 12y/o survivor of sexual abuse by her father. extremely withdrawn and unresponsive, her father had been molesting her at night, jolene told mother and he was sent to prison. father framed it as “our special time together”
-individual therapy to develop trust. write a letter to 12 year old who had been sexually abused by father. CBT to be able to see motivations better. help jolene identify good men.
peer relations, grade, and adjustment improved to almost normal after 1 year

73
Q

ARFID avoident restrictive food intake disorder

A

significant weight loss: inability to maintain normal growth
malnutrition
dependence on enteral feeding or oral supplements
marked interference with psychosocial functioning
prevalence: 3-10% of children in normally developing populations.

74
Q

Anorexia Nervosa

A

restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental history, and physical health
intense fear of gaining weight or becoming fat that interferes with weight gain, even though at a significant low weight
disturbance in the way one’s body weight or shape is experienced, undue influence of body weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
specify: - binge eating/purging or restricting
partial or full remission
severity (BMI percentiles)

74
Q

eating disorder sex differences and prevalence

A

sex differences: 9 out of 10 cases involve girls
Prevalence:
.9-2% anorexia
1.1-4.6% bullemia
.2-3.5% binge eating
most adolescents do not meet full diagnostic criteriab

75
Q

BULIMIA NERVOSA

A

recurrent episodes of binge eating, loss of control when eating, disassociation
recurrent inappropriate compensatory behavior to prevent weight gain
at least once a week for 3 months
self-evaluation unduly influenced by body shape/weight
disturbance does not occur exclusively during episodes of anorexia

only diff between bulimia and anorexia binge/purge type is WEIGHT

76
Q

behavioral precursors to eating disorders

A

restrained eating/fear of fatness in children
extreme weight concern in middle school girls

77
Q

eating disorder co-occurring disorders

A

anorexia: anxiety, ocd, mdd
bulimia: mdd, anxiety, alcoholism, personality disorders (BPD), suicidal
binge eating: similar to bulimia

78
Q

severe health risks of eating disorders

A

electrolyte imbalance that monitor important body functions
re-feeding must be done very carefully and under medical supervision
osteopenia: reduced bone mass
erosion of dental enamel
obesity
low self esteem

79
Q

course and prognosis of eating disorders

A

anorexia: 2 peak onset ages– 14 and 18 (stressful transition periods)
most recover, 20% improve but may show residual symptoms, 10-12% show chronic symptoms
about 6% die (half from suicide, some by starvation, other health problems) 57x higher chance of committing suicide

bulimia: age of onset 18, chronic course marked by relapses and recovery periods.

BED: similar relapse and recovery pattern as BN
age of onset 19

diagnostic switching - anorexia overtime switches to bulimia and vice versa

80
Q

case study eating disorders: video

A

some children have medical problems that make eating painful, other children didn’t get hungry. some children learn they get attention if htey don’t eat.

81
Q

eating disorder etiology

A

neurochemical (disturbances in serotonin) kaye et al: serotonergic functioning (mostly with anorexia with bulimia at lower levels)

personality traits and neurocognitive processes
-negative emotionality and perfectionism: longitudinal studies linked predictively to attitudes of drive for thinness and eating, depressive and anxiety disorders) not specific risk factors
inhibatory control and set shiftings.

82
Q

risk precursors and correlates for eating disorders

A

distorted body image; drive for thinness
AN: embrace one’s symptoms as desirable and signs of control and achievement, large levels of resistant to treatment
BN: symptoms seen as extremely distressing, experience deep shame and depression, more likely to seek help and engage positively in treatment

low birth weight; early feeding difficulty
personal and family weight history (overweight is a risk factor especially VN and VED, environmentla and viologicla risks)

adolescent and adult transitions are stressful
peers and media
culture
-anorexia found in every culture
-bulimia strongly linked to spread of western cultural influences, media, ideas

83
Q

bulimia, integrative perspective

A

emotion dysregulation
binging reflects attempts to self sooth
cascade of viological and psychological consequences
reciprocal associations with depression
vicious cycle becomes self reinforcing

84
Q

EATING DISORDER TREATMENT bulimia

A

easier to treat than anorexia
primary treatment is CBT; exposure therapy, journaling
antidepressants
therapy should address potential for relapse explicitly because hills and valleys are common in treatment
FAMILY COMPONENT ESSENTIAL

85
Q

EATING DISORDER TREATMENT: anorexia

A

cbt is the treatment of choice
weight restoration to save life
harmful cognitions and behaviors addressed
define as a psychological disorder
family therapy: treatment of choice for adolescents living at home using evidence-based techniques

86
Q
A

child psychopathology (2 decks)

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