integration & relationships between disorders Flashcards
sexual function and EDs
anorexia nervosa
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
Women w/ AN report pervasive sexual dysfunction - including decreased sex drive, heightened sexual anxiety, sexual infrequency, difficulties with arousal, lubrication, orgasm, sexual satisfaction, and sexual pain
The restricting type tends to report greater sexual difficulties - why?
- Diminished levels of reproductive hormones
- Endocrinological dysfunction associated with amenorrhea (loss of menstruation)
- Hypogonadism as a result of extreme caloric restriction/malnutrition
- Lower BMI associated w/sexual anxiety and loss of libido
More extreme weight loss = greater sexual dysfunction, while weight restoration often leads to improved sexual satisfaction and increased libido
sexual function and EDs
bulimia nervosa
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
Although research on sexual function in women with BN points to sexual difficulties - several studies have found sexual problems to be more severe in women with AN
Women with BN are more likely to report being in a romantic relationship, have higher sexual esteem, and engage in sexual activity more frequently than AN women
BN women as more likely to engage in risky sexual behaviors - i.e., earlier sexual debut and sexual disinhibition
- Given that BN are more prone to self-harm behaviors, risky sexual behaviors have been hypothesized to represent forms of self-harm
sexual function and EDs
binge eating disorder
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
The sexual function of obese women w/ BED was more impaired compared w/ obese subjects w/ out BED and controls
- Emotional eating = sexual dysfunction in BED women
- Greater frequency of objective binges = lower orgasmic ability, sexual satisfaction, and overall sexual function
Why?
- Being significantly overweight
- Obesity-related gonadal dysfunction
- Reduced vascular function in the genital issues due to metabolic disruptions
- The psychological consequences of obesity
- The metabolic abnormalities resulting from uncontrolled overeating
Most of the effects of BED on sexual function are due to being overweight
sexual function and EDs
longitudinal treatment research
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
Only few such studies
Women who recovered from AN reported notable improvements in sexual problems, whereas women who continued to suffer from ED didn’t
Studies suggest that sexual function tends to improve alongside reductions in ED pathology, but that psychosexual and etiological factors influence this
sexual function and EDs
non-clinical samples
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
The association between sexual function and disordered eating behaviors has also been observed in non-clinical samples
Among undergraduate females, binge-purge symptoms, body dissatisfaction, and drive for thinness were associated with more body- and performance- based cognitive disruptions during sex activity, as well as lower sexual self-efficacy across multiple areas
EDs and sexual dysfunction as internalizing psychopathology
Hierarchical Taxonomy of Psychopathology (HiTOP)
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
HiTOP = a new classification system of mental disorders derived from the structural analysis of empirical research
Constructs psychopathology based on covariation of symptoms, grouping related symptoms together while combining co-occurring syndromes on a dimensional ‘spectra’
Categorizes sexual problems, eating pathology, fear based disorders, and distress-based disorders (i.e., mood disorders) as subfactors under a a class of internalizing disorders
- There’s significant overlap between the sub-spectra of internalizing disorders, w/ conditions of sexual function, disordered eating, and mood representing common comorbid conditions w/ etiological similarities
EDs and sexual dysfunction as internalizing psychopathology
Laurent & Simons’ HiTOP model
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
Centre of this model depicts the spectrum of internalizing conditions according to the HiTOP framework
Grouping co-occurring disorders under a single taxonomical approach → accounts for issues of heterogeneity, comorbidity, diagnostic instability and boundary problems
Each syndrome of each of the four disorder groups interacts with and influences other symptoms
- groups are: fear, sexual problems, eating pathology & distress
The model includes etiological hypotheses (i.e., causal factors) from different branches/accounts within psychological science
In sum, the figure illustrates how eating pathology, sexual dysfunction, anxiety, and depression relate to one another under a large internalizing dimensions
EDs and sexual dysfunction as internalizing psychopathology
body image issues
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
implicated in both sexual difficulties and EDs
Primary feature of all EDs
Strong association between poor body image and sexual difficulties
Proposed as a mediator of the association between sexual function and disordered eating
EDs and sexual dysfunction as internalizing psychopathology
stice’s dual pathway model
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
explains how sociocultural risk factors related to body image interact with psychological and behavioral factors in the development of ED symptoms
Specifically, socio culturally prescribed ideals for body image and stereotype internalization → lead to body image dissatisfaction → leads to dietary restraint and depression → resulting in the development of an ED
E.g., those who endorsed a greater drive for thinness showed more sexual function difficulties
EDs and sexual dysfunction as internalizing psychopathology
personality characteristics and sexuality
Dunkley (2020)
Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective
ED described as being high in perfectionism → tended to display comparatively higher levels of healthy sexuality and lower levels of seductive and destructive sexuality
ED with constricted/overcontrolled personalities → exhibited lower levels of healthy sexuality and tended to present themselves as being non-sexual, and childlike in appearance/mannerism
ED with emotionally dysregulated/undercontrolled personalities → reported higher rates of binge/purge behaviors and higher levels of seductive sexuality with a similarly destructive and impulsive sexual style
neurotransmitters and sexual functioning
Zemishlany (2008)
The Impact of Mental Illness on Sexual Dysfunction
Dopamine:
- The dopaminergic system is involved in all components of male sexual behavior
- Dopaminergic agonists have been reported to arouse sexual behavior
- Central dopaminergic blockers (like antipsychotics) suppress sexual functioning
Serotonin (5-HT):
- May facilitate, inhibit, or have no effect on sexual behavior, depending receptor subtype
- Suggested that the activation of the 5-HT2 receptor impairs all stages of sexual response in males and females
Epinephrine:
- Inhibits erectile response in men → blocking epinephrine receptors stimulates erection
- By contrast, in women it facilitates vasocongestion → suppressing it impairs sexual arousal/orgasm
Norepinephrine:
- Levels increase during sexual arousal in both men and women
Acetylcholine:
- For males, it facilitates erections
- In females, unclear
sexual dysfunction in schizophrenia patients
Zemishlany (2008)
The Impact of Mental Illness on Sexual Dysfunction
Prone to experience SD as a part of the nature of the disease
- Few interpersonal relationships and lack of sexual experience
- Neg symptoms, such as anhedonia and blunted affect severely hamper the ability to enjoy sexual life
Regularly treated with antipsychotics whose common mechanisms (at least for the typical antipsychotics) is blockade of postsynaptic D2 dopaminergic receptors
Atypical antipsychotics as a group have a number of potential advantages over typical antipsychotics in minimizing sexual dysfunction
- bcuz they dont bring about a massive blockade of dopamine transmission
sexual dysfunction in depressive patients
Zemishlany (2008)
The Impact of Mental Illness on Sexual Dysfunction
Decreased libido commonly accompanies an episode of major depression
It seems that depression in men is associated with a potentially reversible decrease in erectile capacity which may be associated with significant sexual dysfunction
Patients treated with SSRIs have a high incidence of sexual dysfunction → results in deterioration in the QOL and causes the patients to stop drug treatment
anxiety disorders and sexual functioning
Zemishlany (2008)
The Impact of Mental Illness on Sexual Dysfunction
Performance anxiety = a well-known phenomenon in men who are concerned over their erectile response and durability of the erection
Vicious cycle of anxiety: anxiety → diminished performance → this diminished performance serves as a confirmation/maintaining factor to the anxiety → reinforcing it and maintaining the pathology
How anxiety influences sexual responses in social phobia:
- In normal males, presenting an erotic and an anxiety-provoking stimuli led to increased arousal, compared to when just shown an erotic stimulus
- However, when SP men were shown this, they reacted to the anxiety- provoking stimuli with decreased arousal
- = anxiety affects sexually functional and dysfunctional males in opposite ways
sexual dysfunction are prevalent among PTSD patients (around 80%) - mostly ED and premature ejaculation
In conclusion, anxiety disorders are associated with a significant impairment in all domains of sexual functioning
sexual dysfunction in patients with BPD
Zemishlany (2008)
The Impact of Mental Illness on Sexual Dysfunction
BPD is characterized by being intense and unstable, having abandonment fears and by vacillating between idealization and devaluation
- These could be expected to interfere w/ sexual function
Sexual trauma is very common in BPD patients → has been consistently linked to avoidance of sexual experiences
- The sexual difficulties are mostly in females and this gender is much more likely to have had experienced sexual abuse = hence sexual abuse could moderate the relationship between BPD and SD
sexual minority individuals and EDs
sexual minority boys & men
Nagata (2020)
Emerging trends in eating disorders among sexual and gender minorities
Gay and bisexual adolescents boys and adult men have a greater prevalence and an increased likelihood of ED behaviors
Sexual minority adult men also experience greater rates of ED behaviors and body dissatisfaction compared w/ heterosexual men
ED behaviors among sexual minority men do not occur in isolation - depression, perceived stigma associated with sexual orientation, and lower self-compassion predicted a positive ED screen, among cisgender gay men
sexual minority individuals and EDs
sexual minority girls & women
Nagata (2020)
Emerging trends in eating disorders among sexual and gender minorities
Adolescent girls and adult women who identify as a lesbian/bisexual are also at risk of ED behaviors;
- Greater prevalence of using diet pills, purging via vomiting/laxative use, and had a greater prevalence of lifetime use of anabolic steroids
Women who identify as a sexual minority reported greater body dissatisfaction and had a greater eating pathology
sexual minority individuals and EDs
minority stress theory
Nagata (2020)
Emerging trends in eating disorders among sexual and gender minorities
has been used to explain the disproportionate rates of ED behaviors and body dissatisfaction among sexual minorities
Experiences related to gender and sexual orientation, such as minority stress, heterosexism, and sexual objectification, may lead to ED behaviors and body dissatisfaction among sexual minority women
Similarly, among gay men, perceived stigma, is positively associated with ED behaviors
Appears that the social experiences of sexual minorities contribute to ED behaviors and body dissatisfaction
transgender people & EDs
Nagata (2020)
Emerging trends in eating disorders among sexual and gender minorities
A small but growing literature indicates that trans people may uniquely experience body image dissatisfaction and EDs
A perceived mismatch with one’s own body and sociocultural body ideals may lead to body dissatisfaction
Social stigma and minimal social support may exacerbate symptoms
the mechanisms of sleep in insomnia
Chistensen & Short (2020)
The case for investigating a bidirectional association between insomnia symptoms and ED pathology
Circadian processes - in normal sleep, circadian processes contribute to varying levels of wakefulness and sleepiness throughout the day
Homeostatic processes - directly related to time awake in a linear fashion, such that the longer an individual is awake, the stronger the sleep drive
These work in conjunction, facilitating sleep onset and maintenance
For indiv w/ insomnia, these processes become interrupted → leading to difficulties with sleep onset and maintenance
Insomnia ppl often engage in coping behaviors that dysregulate the circadian and homeostatic processes and maintain dysregulated sleep
- E.g., ‘sleeping in’ to make up for poor sleep; napping to compensate
Likely that there’s a bidirectional association between sleep and eating processes - such that eating pathology disrupts sleep and dysregulation in sleep influences eating behaviors
mechanisms underlying associations between ED and insomnia
ED behaviors and cognitions disrupt sleep processes
Chistensen & Short (2020)
The case for investigating a bidirectional association between insomnia symptoms and ED pathology
Vigorous exercise shortly before bedtime increases sleep-latency and decreases sleep efficiency
Sleep may be a means to avoid eating, aversive emotions, or distressing situations
- Problematic because daytime napping decreases sleep load and results in less drive to fall asleep at appropriate bedtimes
Binge-eating episodes, which are common in evenings, may disrupt sleep cycles by delaying bedtime or interfering with sleep onset/quality due to increased arousal, fullness, or digestive processes
Being on a large caloric restriction may lead to difficulties with sleep onset due to hunger, or may facilitate daytime sleep onset due to fatigue and malnutrition
mechanisms underlying associations between ED and insomnia
ED negative affect & insomnia
Chistensen & Short (2020)
The case for investigating a bidirectional association between insomnia symptoms and ED pathology
proposed that daytime neg affect is a core maintenance factor for insomnia
ED indiv report high levels of worry/rumination - elevated neg affect is a risk factor for ED
= possible that global and/or ED-specific repetitive neg thought in the pre-sleep period contributes to the development and maintenance of insomnia in those with EDs
Possible that affective disorders, commonly comorbid with EDs could mediate associations between ED symptoms and insomnia
mechanisms underlying associations between ED and insomnia
prolonged starvation & insomnia
Chistensen & Short (2020)
The case for investigating a bidirectional association between insomnia symptoms and ED pathology
Prolonged starvation - likely impacts sleep processes through the dysregulation of orexin receptors
Orexins = neuropeptides that are hypothesized to increase during starvation to promote wakefulness and food-searching behavior
mechanisms underlying associations between ED and insomnia
dysregulated sleep processes contribute to ED behaviors
Chistensen & Short (2020)
The case for investigating a bidirectional association between insomnia symptoms and ED pathology
Acute sleep deprivation is associated with increased tendency to crave and consume high-calorie foods
Chronic insomnia has been associated with dysregulated levels of leptin and ghrelin, which regulate hunger/satiety and influence food consumption
Overall, mechanisms linking insomnia to specific ED behaviors remain primarily hypothetical and understudied at this time and more research is needed
