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Final Flashcards

1
Q

How does the eating pathology category challenge HiTOP conceptualization and categories?

A
  • Bulimia and binge eating have more externalizing features
  • Anorexia has more internalizing features
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2
Q

What are the key symptoms of eating disorders?

A
  • Cognitive Restraint
  • Dietary Restriction
  • Binge Eating
  • Compensatory Behaviours (purging & non-purging)
  • Weight/Shape Concern
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3
Q

Describe cognitive restraint in eating disorders

A

Cognitive effort focused on the intent to reduce the amount of food consumption

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4
Q

Describe dietary restriction in eating disorders

A
  • Actual decrease in energy intake
  • Changing the frequency, quantity or types of food
  • Ex: amount of food eaten and/or what foods are eaten
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5
Q

Describe binge eating in eating disorders

A
  • Consuming an objectively large amount of food
  • In a discrete (short) period of time
  • With a feeling of loss of control (person wants to stop eating but can’t)
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6
Q

Describe compensatory behaviours in eating disorders

A

Purging:
- Attempt to physically remove food from system
- Ex: self-induced vomiting, consuming laxatives, diuretics
- These behaviours provide people with temporary relief (relieve negative affect)
- These are ineffective at reducing the calories
- These behaviours can have detrimental effects on health overtime

Non-Purging:
- Counteract the ingestion of food indirectly
- These function primarily to reduce the emotions linked with food
- Ex: restriction (after eating a lot, engaging in restriction of consumption to make up for it), compensatory exercise

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7
Q

What are some examples of the detrimental effects that purging behaviours can have on health overtime?

A
  • Vomiting can lead to dental problems, oesophageal problems, high GI problems
  • Laxatives overuse is associated with lower GI problems
  • Diuretics linked with very low levels of electrolytes
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8
Q

Describe weight/shape concern in eating disorders

A
  • A relationship with one’s weight/shape characterized by:
  • Body dissatisfaction
  • Preoccupation with weight/shape
  • Over-valuation of weight/shape
  • Weight and/or shape play an excessively important role in determining self-worth
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9
Q

Describe Anorexia Nervosa (AN)

A
  • Term introduced in 1873 by Sir William Gull -> older concept
  • Anorexia means absence of appetite
  • Anorexia Nervosa means anxious nervous absence of appetite
  • Anorexia Nervosa is the diagnosis
  • Cases/phenomena have been described for centuries
  • Typically present: body dissatisfaction, weight concerns, undue influence of weight/shape on self-esteem
  • Sometimes present: binge eating, purging, excessive exercise
  • Extreme/intense fear of gaining any weight and often altered perception of shape of body
  • Sub-types of either restrictive only (someone who only engages in restrictive eating) or binge-purge
  • Atypical anorexia (when all of these behaviours are present but no BMI issues)
  • Men are less likely to be diagnosed with AN because of high muscle mass
  • There’s often denial about having a problem -> this makes treatment complicated
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10
Q

Describe Bulimia Nervosa (BN)

A
  • More recent: 1979 (Gerald Russell)
  • Noticed patients that used a pattern of binge eating followed by self-induced vomiting
  • Descriptions of binge-eating go back further
  • Typically present: body dissatisfaction, weight concerns, dietary restrictions
  • People with BN unlike with AN are more typically a normal weight or slightly overweight
  • Severity of BN is based on frequency and severity of compensatory behaviours
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11
Q

What are the DSM diagnoses of eating disorders

A
  • Anorexia Nervosa (AN)
  • Bulimia Nervosa (BN)
  • Binge Eating Disorder (BED)
  • Both BN and AN don’t require significant distress or impairment for diagnosis
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12
Q

What are the core features of Anorexia Nervosa (AN)?

A
  • Weight that’s significantly lower than expected for height and age (usually, BMI < 17.5)
  • Dietary restrictions
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13
Q

What are the core features of Bulimia Nervosa (BN)?

A
  • Binge eating
  • Compensatory behaviors
  • Undue influence of weight/shape on self-esteem
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14
Q

What are the core features of Binge Eating Disorder (BED)?

A
  • Binge eating (binge episodes with purging or other compensatory behaviours)
  • Absence of compensatory behaviors
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15
Q

Describe Binge Eating Disorder (BED)

A
  • Binge episodes with engaging in purging or other compensatory behaviours
  • Usually in normal or overweight weight range
  • Severity based on frequency and amount of binge episodes
  • Sometimes present: body dissatisfaction, weight concerns, dietary restrictions
  • Must have significant distress
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16
Q

Describe Avoidant/ restrictive food intake disorder (ARFID)

A

○ Failure to meet energy needs accompanied by significant weight loss
○ Significant nutritious deficiency
○ Can’t be explained by lack of food or culture
○ Food is available and they’re choosing not to consume it
○ Atypical -> seems to not be related to weight or shape of body

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17
Q

What are the residual diagnostic categories for eating disorders?

A
  • Avoidant/ restrictive food intake disorder (ARFID)
  • Other Specified Feeding and Eating Disorder (OSFED)
  • Unspecified Feeding and Eating Disorder (USFED)
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18
Q

Describe Other Specified Feeding and Eating Disorder (OSFED)

A
  • Subthreshold AN, BN, BED
  • Atypical AN
  • Purging Disorder (engaging in purging without binges)
  • Night Eating Syndrome (eating a lot at night)
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19
Q

What percentage of treatment-seeking individuals with eating disorders meet criteria for OSFED/USFED?

A

Between 30-50%

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20
Q

Describe the diagnostic migration of eating disorders

A
  • Individuals who meet criteria for one eating disorder at one point in time are very likely to meet criteria for another eating disorder at another point in time
  • AN-restricting subtype (AN-R) and AN-binge-purge subtype (AN-BP) often migrate with each other
  • AN-binge-purge subtype (AN-BP) and BN often migrate with each other
  • BN and BED often migrate with each other
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21
Q

What are the statistics for the eating pathology among women in Montreal?

A
  • 8.7% frequent compensatory behaviours
  • 4.1% frequent binge eating (objective)
  • 1.1% regular purging behaviours
  • 14.9% residual, OSFED-type category
  • 0% AN
  • 0.6% BN
  • 3.8% BED
  • 0.6% purging disorder
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22
Q

Describe AN epidemiology

A
  • Prevalence: 0.7% (rare)
  • Gender ratio: 10 women:1 men
  • Age of onset: late adolescence
  • Mortality: 5.1%
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23
Q

Describe BN epidemiology

A
  • Prevalence: 1-3%
  • Gender ratio: 10 women:1 men
  • Age of onset: late adolescence - early adulthood
  • Mortality: 1.7%
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24
Q

Describe BED epidemiology

A
  • Prevalence: 2-5%
  • Gender ratio: 2 women:1 men
  • Age of onset: early - mid adulthood
  • Mortality: more research needed
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25
Q

Which eating disorder is more prevalent in boys and has an onset in infancy?

A
  • ARFID
  • Much less common for onset in adulthood
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26
Q

Describe the SWAG stereotype for the epidemiology of eating disorders

A
  • Skinny White Affluent Girls (SWAG)
  • Underweight = < 6% of ED population
  • Males = 25% of ED population -> likely because of different presentations in males
  • Sexual and gender minorities have higher ED prevalence
  • Ethnic minority populations have high rates of EDs
  • Multiracial individuals + Indigenous have highest rates of EDs
  • No relationship between high SES and EDs -> but there is an association with food insecurity
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27
Q

What are some common differential diagnoses with eating disorders?

A
  • Body Dysmorphic Disorder (people have a distorted sense of their body)
  • Obsessive Compulsive Disorder (ritualistic and obsessive thoughts present in eating disorders followed by compulsions to undo the thoughts)
  • Anxiety disorders (esp. SAD, GAD)
  • Depression
  • Psychosis-spectrum disorders
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28
Q

What are some effects of malnutrition?

A
  • Low mood
  • Anhedonia
  • Insomnia
  • Preoccupation and rituals related to food
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29
Q

What are some extensive comorbidities with eating disorders?

A
  • Mood disorders
  • Substance disorders
  • Personality disorders
  • Anxiety disorders
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30
Q

Describe the comorbidity between eating disorders and depression

A
  • AN: 25-50% concurrent Depression
  • AN: 50-70% lifetime hx Depression
  • BN: even higher
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31
Q

Describe the comorbidity between eating disorders and personality disorders

A
  • Commonly comorbid -> 50-70%
  • Restricting AN and Cluster C Personality Disorders
  • AN-BP and clusters B and C
  • BN and cluster B
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32
Q

Describe the heritability of eating disorders

A
  • AN, BN, BED: mean ~50%
  • Twin and adoption studies have found moderate to high heritability in AN, BN, and BED
  • Disordered eating symptoms: ~50%
  • Increased familial risk
  • Ex: AN -> family members have 4x the risk
  • Heritability not static over development
  • 0% genetic contribution before puberty
  • ~50% emerges after puberty
  • To what extent are ovarian hormones contributing -> concordant changes in eating patterns across the menstrual cycle
33
Q

What are some Gene X Environment Interactions we see with eating disorders?

A
  • Short allele of 5-HTTLPR
  • Parenting style
  • Short allele has been found to interact with parenting styles (ex: parents who are very critical, under involved)
  • Abuse history
  • These lead to AN, BN symptoms, drive for thinness
34
Q

What’s the dominant body ideal in North America?

A
  • Thin ideal
  • Degree to which a person buys into this ideal or believes that being thin is better
  • Photoshop -> even thin women were photoshopped into physically impossible thin bodies
  • Thin-ideal internalization
35
Q

How do eating disorders present in men/boys?

A

○ They present differently
○ Ex: muscle dysmorphia
○ Focus on gaining the right muscle mass
○ Men more likely to use exercise as a compensatory behaviour instead of purging
○ When binging, men report less of a sense of loss of control

36
Q

What are some sociocultural pathways for eating disorders?

A
  • Appearance ideals
  • Fat talk – Self, Family, Peers
  • Weight stigma/bullying
  • Media – Fiji Study
37
Q

What’s fat talk?

A
  • Disparaging comments about body image and eating habits
  • Can be comments about own weight/eating habits or some else’s weight
38
Q

Describe Lydecker et al. (2018) study on parental fat talk

A
  • Examination of frequency of parental “fat talk” (toward the self, the child, and others)
  • Associations between parental “fat talk” and child eating behaviours

Findings:
* Parental “fat talk” directed toward: Self (74%), Others (51.5%) and Child (43.6%)
* Toward the self: associated with parental pathology
* Toward the child: associated with child pathology -> child “fat talk” was most strongly associated with all child eating and weight problems

39
Q

Describe the impact of peers and weight stigma

A
  • Teasing someone about their weight
  • General idea that it’s ok to do so
  • Implying that weight is tied to character (lazy, undisciplined, etc.)
  • Weight stigma has a big impact on pathology
40
Q

Describe the study on weight stigma in high school

A
  • Study of people ~20 yrs old and what they experienced in high school
  • 11% reported frequent weight teasing in high school
  • Those in overweight category were much more likely to be teased
41
Q

Describe the relationship between teasing about weight and thoughts of suicide

A
  • Not teased = 25% have thoughts of suicide
  • Teased by peers = 36% have thoughts of suicide
  • Teased at home = 43% have thoughts of suicide
  • Teased by both = 51% have thoughts of suicide
42
Q

Describe Becker et al. (2004) Fiji Study

A
  • Idea that media exposure is linked to disordered eating or thin idealization
  • In 1995 televisions were introduced in Fiji
  • In 1995: no television, no EDs
  • In 1998 : 11.3% adolescent girls report at least 1 purging behaviour, 74% feel “too fat”
  • In 2007: 45% report at least 1 purging behaviour in the past month, rates of formal eating disorders also increased
  • Persuasive temporal correlational evidence that introduction to western ideals and media is associated with disordered eating
43
Q

Describe Stice (2001) Dual Pathway Model

A
  • Sociocultural pressures and Thin-ideal internalization both lead to Body dissatisfaction
  • Body dissatisfaction leads to Negative affect and/or Restrained eating
  • Negative affect and Restrained eating both lead to Eating disorders
44
Q

Body dissatisfaction is considered the norm among who?

A

Women

45
Q

Describe the Abstinence violation effect or the “f*ck it” effect for eating pathology

A
  • Also used in substance use disorders -> substance use effect
  • Eating pathology cycle
  • Start diet and restrict food (when restricting calories, the body rebels to stay alive)
  • Feelings of hunger (crave high calorie foods)
  • Eat “forbidden” foods
  • Overeat - already “broke” diet (binge episode)
  • Feel guilty and fat
  • Start the diet again and heavily restrict food again (cycle restarts)
46
Q

What are some maintenance factors for eating disorders?

A
  • Perfectionism
  • Low self-esteem
  • Emotion regulation
  • Interpersonal difficulties
47
Q

Describe perfectionism as a maintenance factor for eating disorders

A
  • High standards
  • Fear of failure
  • Self-criticism
  • Well-established maintenance factor for people with eating disorders
  • People with perfectionism features tend to have a more severe course
48
Q

Describe low self-esteem as a maintenance factor for eating disorders

A
  • Omnipresent
  • Unconditional
  • Treatment obstacle -> people hate themselves so it’s hard to motivate them to make changes
  • Don’t just feel bad about weight but also feel bad about everything
49
Q

Describe emotion regulation as a maintenance factor for eating disorders

A
  • Negative mood intolerable -> can’t tolerate high negative affect (need to do something about it)
  • Binge trigger
  • This has been associated with binge episodes and NSSI
50
Q

Describe interpersonal difficulties as a maintenance factor for eating disorders

A
  • Isolation, loneliness and other forms of stress can trigger the onset of disorders
  • Negative interactions precede binges -> common trigger and predictor of binge episodes
  • Having strict rituals around food makes it harder to engage with social fabric they’re within
51
Q

What’s psychotherapy?

A
  • Process in which a professionally-trained therapist systematically uses techniques derived from psychological principles to relieve another person’s psychological distress or promote growth
  • Uses evidence-based treatment
52
Q

What are the major schools of psychotherapy?

A
  • Psychodynamic
  • CBT
  • Humanistic-experiential
  • Integrative/eclectic
  • All of these schools have their own evidence-base behind them
53
Q

How do we establish efficacy?

A
  • For a drug to reach markets, pharmaceutical companies have to first show that the drugs are effective
  • Efficacy: drug does what you think it’s going to do
  • Efficacy for therapies is typically established through RCTs -> RCTs can tell us whether a treatment has a beneficial effect
54
Q

What are RCTs?

A
  • Where you get a large group of people with a disorder and put them either in a group with an already established treatment, in a waitlist group, and in a group with a new treatment
  • Empirically supported therapy
  • Can tell us whether a treatment has a beneficial effect, BUT
  • Issues:
  • Wait-list control for people who are acutely ill?
  • With therapy, it’s possible that different therapists are giving different doses to therapy or giving special ingredients that we may not see in RCTs
  • Patients enrolled in RCTs are usually relatively uncomplicated cases (ex: single dx -> people with psychosis, severe suicidal ideation, etc. are usually excluded)
  • Highly controlled treatments
55
Q

What’s the effectiveness of a treatment?

A
  • Whether a treatment shows that it’s effective outside of highly controlled laboratory setting
  • Does it represent real-world conditions?
56
Q

Describe Empirically Supported Therapies

A
  • Gold-Standard: having gone through empirically supported therapy that meets criteria for designation as an empirically supported therapy
  • Evidence-Based Practice = the integration of the best available research and clinical expertise within the context of patient characteristics, culture, values, and treatment preferences
  • APA and CPA require training programs to train in evidence-based practices
  • Having this structure can be beneficial for treatment
  • Ideally not strict reliance on a single therapy
57
Q

Why do people argue against the criteria for designation as an empirically supported therapy?

A

They argue this approach devalues the perspectives of people in the field

58
Q

What are the 3 Waves of Behaviour Therapy?

A
  • 1st Wave: Classic behaviour therapies
  • 2nd Wave: Incorporation of cognitions
  • 3rd Wave: New Ideas and approaches
59
Q

Describe the first wave of behaviour therapy

A
  • Classic behaviour therapies
  • Built on classical and operant conditioning
  • Systematic desensitization
  • Focus is on behaviours, not thoughts
60
Q

Describe the second wave of behaviour therapy

A
  • Incorporation of cognitions
  • Rise of mainline Cognitive-Behavioral Therapy
61
Q

Describe the third wave of behaviour therapy

A
  • New ideas and approaches
  • Acceptance and Commitment Therapy
  • Mindfulness-based Cognitive Therapy
  • Dialectical Behavior Therapy
  • People who established all of these will typically say these are a variation on CBT
62
Q

What are exposure therapies?

A
  • Strict behavioural therapies
  • Idea that if someone has a fear of something, you will expose them to their fear so they can habituate to the feared object
  • Exposure therapy allows one to ride the anxiety wave multiple times until they habituate
63
Q

How is anxiety like a wave?

A
  • Anxiety is like a wave -> riding the anxiety wave
  • Anxiety has to peak at some point -> it isn’t rising forever, you rise to the peak and then go down
  • However, when people feel their anxiety rising, they’ll engage in avoidance behaviours -> leads to them not experiencing the natural peak
64
Q

Describe the vicious cycle of anxiety

A
  • Begin exposure
  • Exposure (anxiety climbing/rising)
  • Before panic peak, individual engages in avoidance behaviour to escape anxiety
  • Anxiety quickly drops
  • Individual fails to habituate
  • Anxiety trigger returns
  • Cycle restarts
65
Q

Describe the outcome of repeated exposure with anxiety

A

With continuous exposure and habituation/anxiety coasting, the anxiety wave becomes smaller and smaller leading to a mastery of anxiety

66
Q

Describe In Vivo Exposure

A
  • Systematic desensitization through exposure to feared situations or locations, in order to produce extinction of the fear response
  • Imaginal exposure used if the patient cannot be directly exposed to the feared stimuli
  • Used to be flooding procedure (ex: if someone is scared of snakes, you would put them in a pool of snakes)
  • Now commonly use graduated exposure therapy
67
Q

Describe Graduated exposure therapy

A

○ Build a fear hierarchy and establish the least feared situation and gradually go up to the most feared situation
○ This is also used for OCD
○ Important that the therapist does these exposures with the client

68
Q

Describe Interoceptive Exposure

A
  • When the feared stimulus is not external, but instead internal
  • Systematic exposure to feared bodily symptoms
  • Therapist is doing this with the client in every instance
  • Ex: breathing through a coffee straw
  • Exposure to the internal physiological sensations that may accompany panic
  • If client has a panic attack during treatment, this can be an effective learning experience
69
Q

Describe Exposure and Response Prevention

A
  • For OCD
  • Focus is on exposure to feared stimuli without engaging in safety behaviours (ex: compulsions)
  • Operates according to the principles of Pavlovian extinction
  • Exposing self to trigger by refraining from avoidance behaviours and not having negative reinforcement -> leads to habituation
  • Also done for PTSD in some cases
  • Very challenging treatment
70
Q

Describe the Cognitive Triangle

A
  • Thoughts influence feelings and behaviours (2nd wave)
  • Behaviours influence thoughts and feelings
  • Feelings influence behaviours and thoughts
71
Q

What are the different types of cognitive distortions?

A
  • All or nothing thinking (aka black and white thinking -> ex: if I’m not perfect I have failed)
  • Mental filter (only paying attention to certain types of evidence -> noticing our failures but not our successes)
  • Jumping to conclusions (2 types: mind reading -> imagining we know what others are thinking and fortune telling -> predicting the future)
  • Emotional reasoning (assuming that because we feel a certain way, what we think must be true)
  • Labelling (assigning labels to ourselves or other people)
  • Over-generalizing (seeing a pattern based upon a single event, or being overly broad in the conclusions we draw)
  • Disqualifying the positive (discounting the good things that have happened or that you have done for some reason or another)
  • Magnification (catastrophizing) and minimization (blowing things out of proportion or inappropriately shrinking something to make it seem less important)
  • Should/must (using critical words like “should” and “must” can make us feel guilty, or like we have already failed)
  • Personalization (blaming self or taking responsibility for something that wasn’t completely your fault)
72
Q

Describe the CBT Thought Record

A
  • Where were you?
  • Emotion or feeling
  • Negative automatic thought -> encourage patients to say what their immediate automatic thoughts were in the situation
  • Evidence that supports the thought
  • Evidence that doesn’t support the thought
  • Alternative thought
  • Emotion or feeling
  • Goal: getting people to question things that in the moment feel entirely factual to them -> are there other ways to think about this?
  • Even if patient feels 1% less stress, that’s still progress
  • Demonstrates how if we change the way we think, we can change the way we feel
73
Q

What are common treatments for depression?

A
  • Often incorporates a combination of behavioural activation and cognitive restructuring through thought records
  • Behavioural activation: positive reinforcement based form of treatment -> idea that people with depression gain positive reinforcement from everyday activities
  • Ex: setting goals like going to the gym
74
Q

What are common treatments for anxiety and OCD?

A
  • Anxiety and OCD treatment often relies on cognitive restructuring in addition to exposure techniques:
  • In-vivo exposure (systematic desensitization)
  • Interoceptive exposure
  • Imaginal exposure
  • Exposure and response prevention
75
Q

Describe Acceptance and Commitment Therapy (ACT)

A
  • 3rd wave
  • Mainline CBT focuses on disputing thoughts
  • General goals of ACT are to:
  • Foster acceptance of unwanted thoughts and feelings -> idea of letting anxiety flow through you (not putting life to the side to fight anxiety)
  • Stimulate action that improves the circumstances of living -> focus on personal values and then look at in what ways behaviours are interfering with a life that one values
  • Discourage experiential avoidance -> “an unwillingness to experience negatively evaluated feelings, physical sensations, and thoughts” - Hayes (2005)
  • Hayes argued for increasing willingness to experience these things -> letting go of the struggle
76
Q

What’s an example of the importance of ACT that can be demonstrated to a client during therapy?

A
  • Writing down all fears in a certain scenario on sugar packets and then throwing those thought sugar packets to the client and asking them to catch them as they answer questions
  • Demonstrates how it’s difficult to focus on the present when fighting and engaging with thoughts instead of letting them flow through us
77
Q

What are the 6 core pathological processes present with psychological inflexibility?

A
  • Dominance of the Conceptualized Past and Future; Limited Self-Knowledge
  • Lack of Values; Clarity/Contact
  • Unworkable Action
  • Attachment to the Conceptualized Self
  • Cognitive Fusion
  • Experiential Avoidance
78
Q

What are the 6 core therapeutic processes present with psychological flexibility?

A
  • Contact with the present moment (be here now)
  • Values (know what matters)
  • Committed action (do what it takes)
  • Self-as-context (pure awareness)
  • Defusion (watch your thinking)
  • Acceptance (open up)

Psychopathology (6 decks)

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