Psychoapthology final Flashcards
addiction usually refers to
severe substance use disorder, but the term is not actually in the DSM
DSM criteria for substance use disorder
Problematic pattern of use that impairs functioning. Two or more symptoms within a 1-year period:
- Failure to meet obligations
- Repeated use in situations where it is physically dangerous
- Repeated relationship problems
- Continued use despite problems caused by thesubstance
- Tolerance
- Withdrawal
- Substance taken for a longer time or in greater amounts than
intended - Efforts to reduce or control use do not work
- Much time spent trying to obtain the substance
- Social, hobbies, or work activities given up or reduced
- Craving to use the substance is strong
Severity ratings for SUD in DSM
Mild: 2-3 criteria met
Moderate: 4-5 criteria met
Severe: 6 or more criteria met
Tolerance
indicated by either (1) larger doses of the substance being needed to produce the desired effect or (2) the effects of the drug becoming markedly less if the usual amount is taken
Withdrawal
the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount
delirium tremens
delirious symptoms when blood alcohol level drops suddenly
short term effects of alcohol
- acts on gaba receptors in similar way to xanax, stimulating relaxation
- inhibits glutamate receptors, which may cause cognitive effects
- in one study on alcohol effects on driving, the areas of the brain affected were related monitoring errors and making decisions (the anterior cingulate and orbitofrontal cortex)
opioid prevalence
More than 800,000 people over age 12 in the United States reported using heroin in 2015, a slight decline from 2014 but an increase of over 30 percent from 2013
Genetic factors of SUDs
- Children of problem drinkers have higher than average use of alcohol
- Greater concordance in identical than fraternal twins for alcohol use disorder
College campus–specific risk factors for substance use
- fraternity or sorority membership
- low perception of harm
- peer influences
- time of transition
- poor academic performance
- binge drinking
Drug with highest score for harm to others
Alchohol
Drugs with greatest score for harm to users
heroin and crack
The gist of the 12 step program
admitting powerlessness over alcohol, once an addict always an addict, looking to God and asking him to forgive shortcomings, etc.
Is addiction a brain
disease? Interpretation options of Higher dopamine receptor availability in non-addicted individuals
- Reversible brain dysfunction caused by drug use
- Irreversible brain dysfunction caused by drug use
- Other reason for these differences
behavioral changes that happen in drug addiction
voluntary action (abstinence, constrained drug taking) –> sometimes taking when not intending, having trouble stopping, sometimes taking more than intended –> impulsive action (relapse, compulsive consumption)
What are the usual psychological characteristics of individuals who are successful with moderate drinking?
Are psychologically stable
Are well educated
Are steadily employed
Don’t regard themselves as ‘alcoholic’ or ‘problem drinkers’
Don’t subscribe to the disease concept of alcohol problems
Believe controlled drinking is possible
Develop alternatives to drinking as a means of coping with stress
arguments for abstinence being the goal for addicts
- logical treatment goal, because most direct approach
- about half of individuals presenting for treatment are able to achieve abstinence
- people who are dependent on alcohol find that their attempts at controlled drinking are extremely difficult and typically unsuccessful
- it cannot precisely be determined what kinds of people are suited for successful moderation
- professional’s goal to state
drug use has been shown to stimulate what system and why/how (the two models)
dopamine system - particularly mesolimbic pathway
evidence for both problems with pathway leading to vulnerability of some people to substance abuse (vulnerability model), and substance abuse leading to problems with pathway (toxic effect model)
incentive sensitization theory
explains cravings
the dopamine system becomes super-sensitive to the effects of drugs and cues associated with drugs (craving). transition from liking to craving, as a result of drug’s effects on pathways involving dopamine. even cues for a drug can activate the reward and pleasure areas of the brain implicated in drug use
more craving associated with higher likelihood of use
delay discounting and alcoholism
People who are dependent substances discount delayed rewards more steeply than do people not dependent on these substances. value immediate reward as opposed to delayed reward
brain region associated with immediate reward
amygdala and nucleus accumbens
psychological aspects of drug use: emotion regulation
alcohol:
- reduces anxiety and stress under uncertainty, and dampens emotional responses in anxiety-inducing settings
nicotine:
- more relief at intitiation of smoking and after abstinence
- act of inhaling more effective than nicotine
role of distraction:
- effects positive with distraction, negative without
role of expectancies about drugs
people use drugs because they expect it will reduce negative emotions, make them more sociable etc. even if they actually dont. classic experiment: people who thought they were drinking alcohol but were not, behaved more aggressively, suggesting expectancies about alcohol’s effects may play a role.
personality factors in substance use
low constraint, high negative affect and emotionality predict onset of substance use
also low levels of agreeableness and conscientiousness
sociocultural factors of alcohol consumption
cross-national: men drink more than women
but, varies by the extent to which they drink more across countries, suggesting cultural prescriptions about men drinking more than women are important to consider
social networks; more likely to smoke if peers smoke, or drink alcohol if exposed to alcohol use by parents, etc.
two explanations for how social environment is related to substance us
social influence model
social selection model
- suggests people who are inclined to develop substance use disorder may select social networks that confrom to their own drinking standards
inpatient treatment for alcoholics
the first step is detoxification - withdrawal symptoms are supervised
alcoholics anonymous treatment for alcoholics
- disease view: foundation is that once an addict, always an addict
- during sessions, participants provide testimonials about their addiction and how their lives have improved with the help of AA
- ## provides emotional support, understanding and network - members can call on each other in times of need
problems with alcoholics anonymous
- dropout rate; possibly a result of the program’s strict stance on abstinence
- review found little benefit over other types of treatment
couples therapy for alcoholics
combines the skills covered in individual cognitive behavior therapy, with a focus on the couple’s relationship and dealing with alcohol-related stressors. A meta-analysis of 12 studies found that behaviorally oriented couples therapy was more effective than individual treatment approaches
motivational interventions for alcoholism
1) timeline follow back interview
2) individualized feedback about a person’s drinking in relation to community and national averages, education about the effects of alcohol, and tips for reducing harm and moderating drinking
TLFB was enough to decrease drinking behavior, but in combination with motivation intervention, longer-lasting reduction in drinking was associated up to 1 year
guided self-change approach to treatment
based on belief that people have more control over their drinking than they believe.
heightened awareness of costs of drinking and benefits of drinking less helps.
CBT for drug use disorders
- learn how to avoid high-risk situations
- recognize the lure of the drug
- develop alternatives to using drug
- learn strategies for coping with the craving and for resisting the tendency to regard a slip as a catastrophe.
contingency management for drug use disorders
- teach to reinforce behaviors inconsistent with drug use and avoid situations associated with drug use in the past.
- based on the belief that environmental contingencies can play a role in encouraging drug use
- receiving vouchers, but only works in the short term
motivational enhancement therapy for drug use
combination of CBT techniques and techniques associated with helping people generate solutions that work for themselves
- effective in combo with contingency management for young people
self-help residential homes as treatment for drug use
- separation from social contacts
- enviro where drugs not available, support in transition to drug-free living
- ## role models, usually with lived experience
arguments against abstinence being the goal
- ignores that drinking problems exist on a continuum, so pressuring all people to abstain for life may not be right approach
- some studies show that people who are offered controlled-drinking programs fare better long term than those on abstinence programs
- Experts have defined a set of characteristics of people who succeed with moderate drinking (e.g., being psychologically stable, well-educated, steadily employed).
- Experts believe that more people would do something about their drinking problem at an earlier point if they were offered a choice between abstinence and a moderated drinking program.
names for autism and related “disorders” that were in DSM previously
- pervasive developmental disordrer
- asperger syndrome (high functioning)
- childhood disintegrative disorder (late onset of developmental delays)
DSM criteria for ADHD
- Either A or B:
- 6 or more manifestations of
inattentiveness present for 6 months
to a maladatptive degree, that exceed
what would be expected given
developmental level
- 6 or more manifestations of hyperactivity-inattention for 6 months to a maladatptive degree, that exceed what would be expected given developmental level
- several of above present before age 12
- present in two or more settings
- significant impairment in social, academic or occupational functioning
- only 5 needed if person 17 years or older
Disorder comorbid with ADHD
- conduct disorder
- internalizing disorders such as anxiety and depression (as many as 30% of children with ADHD may have)
Gender prevalence of ADHD
3 times as common in boys than girls
girls with ADHD more likely to have comorbid internalizing, eating and conduct disorders than girls without ADHD, one study found
biological etiology factors of ADHD
- there are dopamine receptor genes implicated in ADHD from genome studies
- children with ADHD have been shown to have smaller dopaminergic areas of the brain than children without , and less activation in frontal areas of brain
- exposure to environmental toxins such as low levels of lead, food additives and maternal smoking (particularly when genetically related mother)
evaluate medical treatments of ADHD
- medications such as Ritalin
- pros:
reduce disruptive behavior and impulsivity and improve ability to focus attention, short-term improvements in concentration, goal-directed activity, classroom behavior, and social interactions with parents, teachers as well as reduction of aggressive behavior
cons: - in longitudinal study of comparison of medication, medication + behavior and behavior with community care, the just medication group was no longer doing better than just community care at 3 year follow up, despite short-term improvements
side effects:
- loss of appetite, weight loss, stomach pain, reduction in height, and sleep problems
Psychological therpaies for ADHD
behavioral interventions such as:
- point systems and daily report cards
- parent training programs, although unsure how effective
- intensive behavioral therapy, which could be as effective as ritalin combined with a less intensive behavioral therapy
Conduct disorder DSM 5
3 or more of the following in the previous 12 months and at least one of them in the previous 6 months:
A. Aggression to people and animals
B. Destruction of property
C. Deceitfulness or theft
D. Serious violation of rules
- Significant impairment in social, academic, or occupational functioning
Etiology of conduct disorders
heritable temperamental characteristics that interact with other neurobiological difficulties and a host of environmental factors
treatments for conduct disorder
parent management training (positively reinforcing prosocial behavior)
family checkup (series of three early intervention sessions to redirect parenting)
multisystemic treatment; targets individual school, peers, on basis that conduct problems are influenced by multiple factors
externalizing disorders
ADHD and conduct disorder
DSM Separation Anxiety Disorder
Excessive anxiety that is not developmentally approprpiate about being away from person to whom one is attached. At least 3 symptoms for 4 weeks:
- repeated distress when separated
- excessive worry that something bad will happen to attachment figure
- refusal to go to school or anywhere
- refusal to sleep away from home
- nightmares about separation
- repeated physical complaints when separated from figure
DSM Specific learning disorder
- difficulties in learning basic academic skills inconsistent with age, schooling and intelligence, persistent for 6 months
- significant interference with academic achievement or daily living
specifiers:
- impairment in reading
- impairment in written expression
- impairment in math
DSM Intellectual Disability
- Intellectual deficits (problem solving, reasoning, abstract thinking) det by intelligence testing and broader clinical assesment)
- significant deficits in adaptive functioning related to:communication; social participation, work or school; independence at home or in the community
- Onset during child development
join attention
interactions that require two people to pay attention to each other, whether speaking or communicating emotion nonverbally. this is impaired in children with autism.
theory of mind
a person’s understanding that other people have desires, beliefs, intentions, and emotions that may be different from one’s own. Develops from ages 2 1/2 to 5. Children with ASD seem not to undergo this developmental milestone and thus seem unable to understand others’ perspectives and emotional reactions.
echolalia
child echoes what they have heard another person say. immediate or delayed.
pronoun reversal
children refer to themselves as “he,” “she,” or “you” (or even by their own name)
communication deficits in chidlren with autism
echolalia
pronoun reversal
literal in use of words
DSM criteria autism spectrum disorder
- Deficits in social communication and social interactions as exhib- ited by the following:
1. deficits in social and emotional reciprocity
2. deficits in nonverbal communiciation
3. deficit in development of peer relationships appropriate to developmental level - Restricted, repetitive behavior patterns, interests, or activities exhibited by at least two of the following:
1. stereotyped repetitive speech, motor movements or use of objects
2. excessive adherence to routines, or extreme resistance to change
3. very restricted interests that are abnormal in focus
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory environment - onset in childhood
- symptoms limit and impair functioning
repetitive and ritualistic acts in children with ASD
- upset with change
- preoccupied with on specific things
- ordering toys in play, intricate patterns, schedules etc.
- self-stimulatory activities such as: continuous rocking, hand twirling, etc.
- may form strong attachments to inanimate objects
prevalence of ASD
5 times more boys than girls, 1 in 68 children
biological etiologies of ASD
- genetic factors: high heritability, estimates between 0.5 and 0.8, higher concordance rates in identical twins than fraternal
- neurobiological factors: higher brain volume in autistic children, children with ASD show greater brain growth between 12 and 24 months, but stop increasing at ages 4/5. could be due to lack of neuronal pruning. “overgrown” include frontal, temporal, and cerebellar, which have been linked with language, social, and emotional functions
amygdala also bigger in children, but in adolescents, smaller amygdala associated with difficulties in emotional face perception and gaze
Psychological treatments for ASD
Intense behavioral therapy which positively reinforces behaviors that are less aggressive, more compliant and more socially appropriate has shown to be effective. children in the intensive hours fared better than children receiving similar treatments for less than 10 hours a week.
Cluster A personality disorders
Odd/eccentric:
- paranoid
- schizoid
- schizotypical
Cluster B personality disorders
Dramatic/erratic:
- antisocial
- borderline
- histrionic
- narcissistic
Cluster C personality disorders
Anxious/fearful
- avoidant
- dependent
- obsessive-compulsive
DSM 5 for general personality disorder
- An inflexible pattern of inner experience and behavior that is distinct from cultural expectations, and influences at least two of the following:
1. cognition about the self and others 2. affect
3. interpersonal functioning
4. impulse control. - The pattern
1. causes significant distress or impairment
2. isinflexible
3. ispervasiveacrosssituations - onset by early adulthood
- not explained by others
Problems with PD diagnoses using DSM 5
Stability:
- many personality disorders remit over time and symptoms are not as persistent as DSM implies.
- poor test-restest reliability in general
Comorbidity:
- with each other
- 50 percent of people diagnosed with a personality disorder meet the diagnostic criteria for another personality disorder, so it becomes hard to interpret results from research that compares people with specific disorders
Alternative DSM 5 model for PDs
excludes histrionic, dependent, paranoid, and schizoid personality disorders
uses 5 personality trait domains and 25 specific personality trait facets to observe how personality may explain deficiencies in observed functioning starting in adulthood. the scores on these scales are converted to dimensions, which are used to decide which personality disorders fit best
Advantages of alternative DSM 5 model for PDs
- personality trait ratings more stable over time than personality disorder diagnoses
- The 25 dimensional scores provide richer detail than do the personality disorder diagnoses, so clinician can specify which traits are of most concern for a specific client
- Personality traits are related to many psychological disorders (eg negative affect and depression)
- Personality traits robustly predict important life outcomes
DSM-5 Criteria for Paranoid Personality Disorder
4 or more of signs of distrust and suspiciousness:
- Unjustified suspiciousness of being harmed, deceived, or ex- ploited
- Unwarranted doubts about the loyalty or trustworthiness of friends or associates
- Reluctance to confide in others because of suspiciousness
*The tendency to read hidden meanings into the benign actions of others
- Bears grudges for perceived wrongs
*Angry reactions to perceived attacks on character or reputation
- Unwarranted suspiciousness of the partner’s fidelity
DSM-5 Criteria for Schizoid Personality Disorder
4 or more of the following signs of aloofness and flat affect:
- Lack of desire for or enjoyment of close relationships
- Almost always prefers solitude to companionship
- Little interest in sex
- Few or no pleasurable activities
- Lack of friends
- Indifference to praise or criticism
- Flat affect, emotional detachment, or coldness
DSM-5 Criteria for Schizotypal Personality Disorder
5 or more of the following signs of unusual thinking, eccentric behavior, and interpersonal deficit:
- Ideas of reference
- Odd beliefs or magical thinking, e.g., belief in extrasensory perception
- Unusual perceptions
- Odd thought and speech
- Suspiciousness or paranoia
- Inappropriate or restricted affect
- Odd or eccentric behavior or appearance
- Lack of close friends
- Social anxiety and interpersonal fears that do not diminish with familiarity
DSM-5 Criteria for Antisocial Personality Disorder
- must be 18
- evidence of conduct disorder before age 15
-Pervasive pattern of disregard for the rights of others since the age of 15, as shown by at least 3 of:
- Repeated law breaking
- Deceitfulness,lying
- Impulsivity
- Irritability and aggressiveness
- Reckless disregard for own safety and that of others
- Irresponsibility as seen in unreliable employment or financial history
- Lack of remorse
DSM-5 Criteria for Borderline Personality Disorder
five or more of the following signs of instability in relationships, self-image, and impulsivity
- Frantic efforts to avoid abandonment
- Unstable interpersonal relationships in which others are either idealized or devalued
- Unstable sense of self
- Self damaging, impulsive behaviors in at least two areas, such as spending, sex, substance abuse, reckless driving, and binge eating
- Recurrent suicidal behavior, gestures, or self-injurious behav- ior (e.g., cutting self)
- Marked mood reactivity
- Chronic feelings of emptiness
- Recurrent bouts of intense or poorly controlled anger
- During stress, a tendency to experience transient paranoid thoughts and dissociative symptoms
DSM-5 Criteria for Histrionic Personality Disorder
5 or more of the following signs of excessive emo- tionality and attention seeking
- Strong need to be the center of attention
- Inappropriate sexually seductive behavior
- Rapidly shifting and shallow expression of emotions
- Use of physical appearance to draw attention to self
*Speech that is excessively impressionistic and lacking indetail - Exaggerated, theatrical emotional expression
- Overly suggestible
*Misreads relationships as more intimate than they are
DSM-5 Criteria for Narcissistic Personality Disorder
5 or more of the following signs of grandiosity, need for admiration, and lack of empathy
- Grandiose view of one’s importance
- Preoccupation with one’s success, brilliance, beauty
*Belief that one is special and can be understood only by other high-status people - Extreme need for admiration
- Strong sense of entitlement
- Tendency to exploit others
- Lack of empathy
- Envious of others
- Arrogant behavior or attitudes
DSM criteria for avoidant personality disorder
4 or more of following behavior patterns of social inhibition, feelings of inadequacy, and hypersensitivity to criticism:
- Avoidance of occupational activities that involve significant interpersonal contact, because of fears of criticism or disapproval
- Unwilling to get involved with people unless certain of being liked
- Restrained in intimate relationships because of the fear of being shamed or ridiculed
- Preoccupation with being criticized or rejected
- Inhibited in new interpersonal situations because of feelings
of inadequacy - Views self as socially inept, unappealing, or inferior
- Unusually reluctant to try new activities because they may prove embarrassing
DSM 5 dependent personality disorder
5 of following showing excessive need to be taken care of:
*Difficulty making decisions without excessive advice and reassurance from others
* Need for others to take responsibility for most major areas of life
* Difficulty disagreeing with others for fear of losing their support
Difficulty doing things on own or starting projects because of lack of self-confidence
* Doing unpleasant things to obtain the approval and support of others
* Feelings of helplessness when alone because of fears of being unable to care for self
* Urgently seeking new relationship when one ends
* Preoccupation with fears of having to take care of self
DSM5 obsessive compulsive personality disorder
Intense need for order, perfection, and control, as shown by the presence of at least 4:
- Preoccupation with rules, details, and organization to the extent that the point of an activity is lost
- Extreme perfectionism interferes with task completion
- Excessive devotion to work to the exclusion of leisure and friendships
*Inflexibility about morals and values *Difficulty discarding worthless items - Reluctance to delegate unless others conform to one’s standards
*Miserliness
*Rigidity and stubbornness
Treatment of personality disorders
- people often go to treatment for comorbid conditions, but it is important for clinicians to be able to recognize personality disorders, as they predict slower improvements in psychotherapy
cognitive therapy: restructure negative thought patterns and cognitive beliefs that are at the heart of personality disorders, shows that this kind of psychotherapy can be effective.
psychodynamic therapy: suggests childhood experiences and conflicts are at root of personality, so the aim is to reconsider these experiences and build awareness of how they shape their current behaviors.
mild cognitive impairment (MCI)
a label for the early signs of decline before functional impairment
DSM5 for mild neurocognitive disorder
Modest cognitive decline from previous levels in one or more domains based on both of the following:
- Concerns of the patient, a close other, or a clinician
- Modest neurocognitive decline (i.e., between the 3rd and 16th percentile) on formal testing or equivalent clinical evaluation
- deficits do not interfere with independence in everyday activities even though greater effort, compensatory strategies may be needed for independence
- deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder
DSM5 major neurocognitive disorder
- Significant cognitive decline from previous levels in one or more domains based on both of the following:
- Concerns of the patient, a close other, or a clinician
- Substantial neurocognitive impairment (i.e., below the 3rd percentile on formal testing) or equivalent clinical evaluation
- deficits interfere with independence in every- day activities
- deficits do not occur exclusively in the context of delirium and are not due to another psychological disorder
gender dysphoria
the distress that may accompany the incongruence between one’s experience/expressed gender and one’s assigned gender. More specifically defined when used as a diagnostic category
Suicidal rate of ppl w/ gender dysphoria
30 - 50
risk factors for suicide, for ppl w/ gender dysphoria
past maltreatment, gender victimization, depression, substance abuse, younger age
high levels of stigmatization, discrimination and victimization
pros of keeping gender dysphoria in DSM
- recognition of distress that is experienced
- diagnosis helps gain insurance coverage for treatment in some countries
- gives incentive for research
- ppl consider that the change of label (from Gender Identity Disorder) was sufficient
cons of keeping gender dysphoria in DSM
- distress associated w/ gender dysphoria is arguably caused by difficulties encountered from social disapproval of alternative genders, not from the incongruence itself
- diagnosis is stigmatizing
- outdated western binary view on gender
cultural differences in gender
Fa’afafine in Polynesia identify as having third gender or non-binary role.
not hard to accept who they are, until had to live abroad as “transgender” woman
Psycho-pathologization of trans people
- labelling gender variance as mental disorder is based on erronous sex binary and the misattributions of of the causes of stress that trans people experience
- reflects Western civilization’s medicalization of social issues
- labelling of trans people as mentally disordered echoes psychiatric labelling of gay people
paraphilic disorders
recurrent sexual attraction to unusual objects or sexual activities lasting at least 6 months
fetishistic disorder DSM
- recurrent and intense sexually arousing fantasies, urges, or behaviors involving the use of nonliving objects or non- genital body parts for at least 6 months
- causes significant stress or impairment
- the sexually arousing objects are not limited to articles of clothing used in cross-dressing or to devices designed to provide tactile genital stimulation
transvestic disorder DSM
cross-dressing for sexual gratification
pedophilic disorder DSM
- recurrent and intense sexually arousing fantasies, urges, or behaviors involving sexual contact with a prepubescent child for at least 6 months
- acted on these urges, or the urges cause marked distress or interpersonal problems
- Person is at least 16 years old and 5 years older than the child
voyeuristic disorder DSM
- recurrent and intense sexually arousing fantasies, urges, or behaviors involving the observation of unsuspect- ing others who are naked, disrobing, or engaged in sexual activity for at least 6 months
- Person has acted on these urges with a nonconsenting person, or the urges and fan- tasies cause marked distress or interpersonal problems
-the thrill of being caught is important
exhibitionistic disorder DSM
- recurrent and intense sexually arousing fantasies, urges, or behaviors involving the exposing one’s genitals to an unsuspecting person, for at least 6 months
- Person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems
frotteuristic disorder DSM
- recurrent and intense and sexually arousing fantasies, urges, or behaviors involving touch- ing or rubbing against a non- consenting person for at least 6 months
- Person has acted on these urges with a nonconsenting person, or the urges and fan- tasies cause clinically signif- icant distress or problems
sexual sadism disorder DSM
- recurrent, intense, and sexually arous- ing fantasies, urges, or behaviors involving the physical or psychological suffering of another person for at least 6 months
- Causes clinically significant distress or impairment in functioning or the person has acted on these urges with a nonconsenting person
sexual masochism disorder DSM
- recurrent, intense, and sexually arous- ing fantasies, urges, behaviors involving the act of being humiliated, beaten, bound, or made to suffer, for at least 6 months
- Causes marked distress or impairment in functioning
anorexia subtypes
- restricting type: weight loss achieved by severely limiting food intake
- binge/purging type: regularly engaged in bingeing/purging
anorexia prognosis
50-70% recover
recovery often takes 6-7 years, relapse is common
10x death rate compared to general population
DSM Anorexia Nervosa
- restriction of food leads to to very low body weight; significantly below normal
- intense fear of weight gain OR repetitive behaviors that interfere with weight gain
- Body Image disturbance
Binge Eating Disorder DSM
- recurrent binge eating episodes
- binge eating episodes include at least 3 of the following:
- eating more quickly than usual
- eating until over full
- eating large amounts even if not hungry
- eating alone due to embarrassment about large food quantity
- feeling bad about the binge
- NO compensatory behavior is present
severity ratings for BED
mild: 1-3 binges/week
moderate: 4-7 binges/week
severe: 8-13 binges/week
extreme: 14+ binges/week
severity rating for Anoraxia Nervosa
measured using BMI
mild: </= 17
moderate: 16 - 16.99
severe: 15 - 15.99
extreme: < 15
key differences between anorexia and bulimia
WEIGHT LOSS: people with anorexia lose tremendous amounts of weight, whereas people with bulimia do not
DSM Bulimia
- recurrent episodes of binge eating
- recurrent compensatory behaviors to prevent weight gain, eg. vomiting
- body shape and weight are extremely important for self evaluation
severity rating bulimia
meausred by frequency of compensatory behaviors
mild: 1-3 binges/week
moderate: 4-7 binges/week
severe: 8-13 binges/week
extreme: 14+ binges/week
cognitive factors of anorexia
- body image disturbance is motivating factor
- behavior that mintains thinness is positively reinforced by sense of self fcontrol, or positive comments from others
- can also be negatively reinforced, by reduction of anxiety around weight gain
cog factors of bulimia and BED
binge may function as means of regulating negative emotion
Psychological treatment of anorexia
THERAPY:
- goal 1: gain weight (operant conditioning behavioral programs)
- goal 2: long term weight maintenance, which remains a challenge
CBT:
- effective after hospitalization to reduce relapse risk, can also help in combination with hospitalization
- family based therapy is effective to0
