midterm 2 Flashcards
list eating disorders
- anorexia
- bulimia nervosa
- binge eating
- PICA
- avoidant restrictive food intake (ARFI)
- EDNOS (eating disorder not otherwise specified - doesnt meet full critieria)
sociocultural factors
- only seen as a white women issue
- fallon & rozin study
- Martinez Gonzalez (2003)
- Pro-Ana Website
physical components of EDs
- dietary restrictions
- compensatory behaviors
- bingeing
what determines a binge
- duration
- cultural context
-personal context - feeling of control
Binge defintion
- eating rapidly
- eating until uncomfortably full
- eating alone (embarrassment)
- eating large amount even when not hungry
- feeling disgusted
- lack of self control
Overating Episodes
- Objective Overeating Episode (OOE)
- Objective Binge Episode (OBE)
- Subjective Overeating Episode (SOE)
- Subjective Binge Episode (SBE)
Anorexia Nervosa
- ego centered
- inaccurate descriptions of their bodies
- lack of seriousness regarding body weight
- fear of becoming fat
- poor physical health (high Morbidity rates)
Subtypes of anorexia nervosa
- binge/purge
- restricting
- crossover of subtypes is common
Bulimia Nervosa
- recurrent binge eating (lack of self control, eating large amount in discrete time periods)
- recurrent compensatory behaviors
Specifc current severity
Mild
1-3 episodes
Moderate
4-7 episodes
Severe
8-13 episodes
Extreme
14 or more episodes
ARFID
- failure to meet appropiate energy needs
- causes psychosocial issues
- seen/treated in childhood (fear of trying new foods, fear of food textures, concerns of nausea, throwing up, etc.)
PICA
- nonnutritive food
- inappropiate to an indivdual’s development
Assesment of ED
- semi structured
- self report (Eating Attitude Test, Eating Disorder Inventory)
- Test meals
Etiology of ED
- cognitive
- affective
-behavioral - interpersonal
Inpatient treatment
-24/7 monitoring
- therapy
- nutrional rehabilitation
- structural environment
Body Dysmorphic Disorder (OCD + ED)
- overwhelmed with flaws in physical appearance
- repetitive behaviors/mental acts
- clinical significant distress (in everyday life)
- appearance concerns are not explained due to another mental disorder
Bigorexia
- obsessiveness with being bigger
- men usually fall under this and under OCD, but not anorexia
Treatments for EDs
Family Based Treatment:
- adolescents, family support
- reduces relapse
Cognitive Behavioral Treatment:
- psychoeducation
- regular eating pattern
- coping strategies
Dialectical Behavioral Treatment (DBT)
- mindfulness + emotional regulation
Interpersonal Therapy (IPT): 10 weeks
- interpersonal relationships+communication
- time/goal oriented
Obsessive Compulsive Disorder
- Obsessions: recurrent + persistent thoughts, impulses or urges
- Compulsions: repetitve acts that a person feels compelled to perform
IMURDER:
- Intrusive
- Mind-based
- Unnwated
- Resistant
-Distressing
- Ego-dystonic
- Recurrent
Common obsessions + compulsions
Obsessions:
- contamination
- doubts about actions
-orderliness/symmetry
- aggressive/horffic impulses
- sexual imagery
Compulsions: helps to reduce anxiety
- repetitive acts (behavioral or mental
- hand washing, checking, counting, rituals
Treatments of OCD
Medication
-Antidepressants (SSRIs)
CBT: Exposure and Response Prevention (EXRP)
- bring anxiety/distress, without compulsions from patients
- helps to identify triggers
Trichotillomania
- A disorder that involves recurrent, irresistible urges to pull out body hair
- Clinically significant distress or impairment
Excoriation/Dermatillomania
- Recurrent skin-picking resulting in lesions or scarring
- Clinically significant distress or impairment
Body Focused Repetitive Behaviors (BFRBs)
- Perfectionistic
- Habitualistic
Treatments for BFRB
- Habit reversal training
- Acceptance and commitment therapy
- support groups
- no medicine
Hoarding Disorder
-Persistent difficulty discarding or parting with possessions
- can affect living spaces
- clinically significant distress or impairment
- not attributable to other condition/disorder
- risk of harm to self and others
-unwillingness to have guest around
Features associated with hoarding
- indecisiveness
- perfectionism
- procrastination
- distractability
- trouble with executive functioning
- lack of family warmth
- family values
- information processing problems
- sorting problems
Anxiety leads to … which leads to…which causes an ongoing cycle
anxiety leads to AVOIDANCE, which leads to RELIEF, which causes an ongoing cycle
Anxiety
Somatic - panic and physical monitoring
Cognitive - rumination (repetitive negative thoughts about oneself) and worry (worry or thought of going crazy, heart attack, etc.)
anxiety behaviors
- learned
- automatic
- anticipatory
- monitoring
- avoidant
- safety
DSM-5 List of Anxiety Disorders:
- Specific phobia
- Panic disorder
- Agoraphobia
- Selective mutism
- Separation anxiety disorder
- Generalized anxiety disorder
- Unspecified anxiety disorder
- Other specified anxiety disorder
- Social anxiety disorder (social phobia)
- Anxiety disorder due to another medical condition
- substance/medication-induced anxiety disorder
Sources of fear and anxiety disorders
Bodily sensations = panic
specific situations = agroaphobia
others’ evaluation = social anxiety
risks = generalized anxiety
phobogen = specific phobia
Cycle of 3 Ps:
Precipitating
Perpetuating
Predisposing
anxiety is central to:
- Trauma
- OCD
- Depression
- Problematic substance use
- Physical illness
- Other mental disorders
-ADHD
-ASD.
Classical and operant conditioning (anxiety)
Fearful event (US) + fear (UR) + neutral stimuli (CS) –> anxiety
Anxiety Trigger →
Avoidance Behavior →
Short-Term Relief →
Reinforced Avoidance →
Long-Term Anxiety Increases
Applications: Behavior Modification for Anxiety
Shaping
Desired behavior
Positive reinforcement
ApS
Aversive conditioning
Unwanted behavior
AvS
Counter conditioning
AvS
Behavior
ApS
Habituation
AvS
Exposure therapy
Cognitive restructuring: step-fact record
-Situation
-Thoughts
-Evidence
-Perspective
-Feelings
-Actions
-Consequences
-Targets
Assessment + treatment of hoarding
assessment: semi-structured interview
treatment:
- safety
- increase patient awareness
- ability to discard items
- improve relationships
- declutter living spaces to regain functionality
limitations:
- ego-syntonic
- thoughts are not distressing
- treatment initated by family members
Neurodevelopmental Disorders
- ADHD
- Specific learning disorders
- elimination disorder
- communication disorders
- autism spectrum disorder (ASD)
DSM-5 Criteria for ADHD
- a persistent pattern of inattention
- a persistent pattern of hyperactivity/impulsivity
- symptoms present before 12
- symptoms present in 2 or more settings (home, school)
- symptoms interfere with/reduce quality of social, academic, occupational functioning
combined type: both inattention and hyperactivity are met past 6 months
Diagnosis of ADHD
- ADHD Self Report
- Barkely ADHD BAARS-IV
- continious performance task
Treatment of ADHD
- medications (stimulant and nonstimulant)
- reduces hyperactivty/impulsivity
-imrpove concentration
BUT:
- side effect
-abuse potential
- does not increase positive behaviors
Behavioral:
- parent training
- classroom management
adult:
- not cure but better manage
- better organizational, planning, time management skills
- parent treatment groups
specifc learning disorder
Difficulties learning and using academic skills
- Inaccurate or slow and effortful word reading
- Difficulty understanding the meaning of what is read
- Difficulties with spelling
- Difficulties with written expression
- Difficulties mastering number sense, number facts, or calculation
- Difficulties with mathematical reasoning
The affected academic skills are substantially and quantifiably below those expected for the
individual’s chronological age, and cause clinically significant impairment
The learning difficulties begin during school-age years but may not become fully manifest until the
demands for those affected academic skills exceed the individual’s limited capacities
The learning difficulties are not better accounted for by:
intellectual disabilities,
uncorrected visual or auditory acuity,
other mental or neurological disorders,
psychosocial adversity,
lack of proficiency in the language of academic instruction, or
inadequate educational instruction
Assessing specific learning disorder
- intelligence assessment
- achievement test
- specific learning ability tests
elimination disorders
by inappropriate or involuntary elimination of urine or feces
Enuresis – repeated urination into bed or clothes (involuntary or intentional)
Encopresis – repeated passage of feces in inappropriate places (involuntary or intentional)
psychological relevance:
Psychologists consider age, cognitive development, and emotional maturity.
Operant conditioning plays a big role:
A child may avoid the toilet due to a negative past experience (e.g., painful bowel movement).
Major Depressive Episode
Five or more of the following symptoms, for at least 2 weeks
Depressed mood, most of the day, nearly every day
Anhedonia (loss of interest in activities) most of the day, nearly every day day
Change in weight or appetite (significant increase by others)
Insomnia or hypersomnia
Psychomotor agitation or retardation (observable by others)
Fatigue or loss of energy
Feelings of worthlessness, excessive guilt
Impaired concentration or indecisiveness
Recurrent thoughts of death or suicide, or a suicide attempt or a specific plan for committing suicide
Clinically significant distress/impairment
Not attributable to other disorder
Bereavement exclusion from DSM-5
defintion: be deprived of a loved one through a profound absence, especially due to the loved one’s death.
What arguments did Kendler make for removing the bereavement exclusion?
Why are we excluded for bereavement? What if there are other stressors in your life (losing a job, house burned down), why would sad things be different from bereavement? Why is it getting special treatment?
What arguments did Horwitz make for retaining the bereavement exclusion?
Will start watering down diagnoses, grief after bereavement doesn’t always show major depression but where are cases where this does occur
grief vs MDD
grief:
- Feelings of emptiness and loss
- Intensity decreases over time, fluctuates with thoughts of the deceased
- Self-esteem is generally preserved
- Thought focus on the deceased
MDD:
- Depressed mood, inability to anticipate happiness or pleasure
- Persistent dysphoria, not tied to specific thoughts
- Pervasive unhappiness and misery
- Feelings of worthlessness, self-loathing
- Thoughts focus on self-critical or pessimistic ruminations
Persistent Depressive Disorder (PDD)
Depressed mood for most of the day, more days than not, for at least 2 year
Poor appetite or overeating
Insomnia or overeating
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feeling of hopelessness
It is possible to have both MDD and Persistent Depressive Disorder (Double Disorder)
HE’S SAD
Hopelessness
Energy loss/fatigue
Self esteem
2 year minimum duration (depressed mood most of the day, more than not)
Sleep disturbance
Appetite increased or decreased
Decision-making or concentration impaired
Models of Depression:
Cognitive-behavioral models
Depression is perpetuated by negative conditions:
Negative schemas → cognitive triad (negative thoughts about myself, the world, and the future)
Activation of negative schema leads to biased processing of current life events
Automatic negative thoughts
Overly-negative interpretations of events
Memory biases for negative information
Interpersonal models
Excessive reassurance seeking
Negative feedback seeking
Interpersonal conflict avoidance
- Unassertive, socially withdrawn, avoidant, and shy
Blame maintenance
Environmental models:
On the one hand, stress leads to depression
In 20-50% of cases, MDD occurs after a stressful event
MDD is more common in groups with low SES, who experience more severe stress
Early adversity predicts MDD
On the other hand
People with a vulnerability for MDD and those who have MDD are more sensitive to negative events
People with MDD tend to generate more stressful events
Biological models
Heritability of MDD is 40-50%
Gene- environment interactions
Psychosis and impacts
syndrome with perceptual disturbance & loss of reality testing
Schizophrenia
suicide risk
unemployment, homelessness, incarcertaion, disability
Prodromal Psychosis
symptoms: illusions, dissociation, mild paranoia, brief hallucinations (with insight)
Mood & anxiety common
Substance use, behavioral changes
Schizoaffective Disorder Diagnosis
Mood episode (manic or depressive) concurrent with schizophrenia symptoms
Delusions/hallucinations for ≥2 weeks without mood symptoms
Mood symptoms present most of the illness
Not due to substances or medical issues
Perceptual disturbances
Hallucinations: auditory (most common), visual, olfactory, gustatory, tactile
Descriptions include: “voices through my teeth,” “bugs dissolving,” “iridescent angel wings,” “paper buildings”
Phenomenology (Lived Experiences) what it is like to be the patient
Shifting visuals under stress: plastic plants, 1D cut-outs
Shadowy “felt” presences, object transformations
“White noise” vision, distorted faces, paranoia
Surreal perceptions: fish in classroom, hovering body, alternate lives
delusions
Types: persecutory, referential, thought insertion/removal, grandiose, somatic, religious, nihilistic (rejecting all religious and moral principles in the belief that life is meaningless.)
Often ideas not based in consensual reality
disorganization
Subjective: thoughts feel tangled, heavy
Speech patterns: flight of ideas, word salad, neologisms (new words), clangs
Negative Symptoms
Alogia: reduced verbal output
Flat affect: emotional bluntness
Anhedonia: lack of pleasure
Avolition: loss of motivation
Asociality: reduced social interaction
Pharmacological Treatment
psychosis
Antipsychotics help with positive symptoms (not always negative or cognitive)
First-gen: higher risk of motor side effects (e.g., tardive dyskinesia)
Second-gen: metabolic side effects (e.g., weight gain, diabetes)
Psychosocial Treatment
Cognitive Behavioral Therapy for psychosis (CBTp)
Cognitive remediation therapy
Supportive therapy
Supported employment, education, and living
Family therapy and psychoeducation
Peer/community support groups
Strategies from Individuals with Lived Experience
Sensory redirection (e.g., fans, weighted blankets)
Humor: reframing hallucinations with creative interpretation
Grounding: journaling, talking back to voices, reminding self of safety
Structure: staying busy, exercise, mindfulness
Medication for reducing anxiety/duration of experiences
Meditation: creating space between self and symptoms
Fear vs. Anxiety
Fear: Immediate, present-oriented, response to specific threat
Anxiety: Future-oriented, diffuse/non-specific threat, anticipatory
When Does Anxiety Become a Disorder?
Too intense (severity)
Doesn’t go away (frequency)
Happens without real threat
Causes distress and/or impairment
Specific Phobias
Marked fear of specific object/situation
Triggers immediate fear/anxiety
Actively avoided or endured with distress
Out of proportion to actual threat
Persistent (6+ months)
Causes distress/impairment
Not better explained by another disorder
Animal
Natural environment (e.g. heights)
Blood-injection-injury
Situational (e.g. flying)
Other (e.g. choking)
Learning theories of phobias
Learning Theory of Phobias (Mowrer, 1960)
Classical Conditioning – fear is learned via:
Direct experience
Observation
Being told
Operant Conditioning – avoidance reduces anxiety (negative reinforcement)
Treatment of phobias
Exposure therapy: face feared object/situation
Use SUDS (Subjective Units of Distress Scale) to track fear
Behavioral techniques → unlearn avoidance
Social Anxiety Disorder (SAD)
fear of social situations involving scrutiny
Fear of showing anxiety or being judged
Situations are avoided or endured with intense fear
Out of proportion to threat
Persistent (6+ months)
Causes distress/impairment
Etiology of SAD
Avoidance Behaviors:
Reinforce anxiety
Safety behaviors (e.g., avoiding eye contact, needing alcohol, rehearsing conversations) = psychological avoidance
Cognitive Biases:
Over-perception of rejection
Joormann & Gotlib (2006): SAD participants detect anger in ambiguous faces faster
Panic Disorder & Panic Attacks
Panic Attack Symptoms (must have 4+):
Rapid heartbeat, sweating, shaking, shortness of breath
Choking, chest pain, nausea, dizziness
Chills, tingling, derealization, depersonalization
Fear of dying, losing control, or going crazy
Agoraphobia
Marked fear or anxiety about ≥2:
Public transportation
Open spaces
Enclosed places
Crowds or lines
Being outside home alone
Avoided due to fear of panic or being unable to escape/get help
Causes significant distress/impairment
Generalized Anxiety Disorder (GAD)
Excessive worry about multiple areas of life for ≥6 months
Difficult to control
At least 3 physical symptoms: fatigue, restlessness, muscle tension, irritability, etc.
GAD Models
Avoidance Model (Borkovec et al., 1998)
Worry is a cognitive avoidance strategy
Reduces distressing imagery by shifting to verbal thoughts
Reinforced by decreased physical arousal
- Intolerance of Uncertainty Model (Dugas et al., 1998)
GAD individuals can’t tolerate ambiguous outcomes
Worry gives a false sense of control
Prefer certain negative outcomes over uncertain ones
Treatment of GAD
SSRIs: First-line medication
Anxiolytics: Short-term relief
Behavioral techniques:
Relaxation, exposure, behavioral activation
Cognitive techniques:
-Restructure beliefs about worry
-Problem-solving vs. excessive worry
-Scheduled “worry time”
Mood Disorders
Major Depressive Disorder (MDD)
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
Panic attack STUDENTS FEAR C’s
S – Sweating
T – Trembling or shaking
U – Unsteadiness, dizziness, or lightheadedness
D – Derealization or depersonalization
E – Elevated heart rate (palpitations or pounding heart)
N – Nausea or abdominal distress
T – Tingling (numbness or paresthesias)
S – Shortness of breath or sensations of smothering
F – Fear of dying
E – Fear of losing control or “going crazy”
A – Agitation (psychomotor agitation or restlessness)
R – Respiratory symptoms (choking sensation or chest pain)
C – Chest pain or discomfort
C – Chills or heat sensations
C – Choking
