Week 11: Eating disorders and substance-related disorders Flashcards
According to the DSM-5 (APA, 2013), eating disorders are characterized by
a persistent disturbance in eating behavior
DSM-5 Criteria for. . . Anorexia Nervosa
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that min-imally expected.
B. Intense fear of gaining weight or of becoming fat, or persis-tent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seri-ousness of the current low body weight.
An important change from DSM-IV to DSM-5 is that in DSM-5 ______ is no longer required for a person to be given the diagnosis
amenorrhea (cessation of menstruation)
There are two types of anorexia nervosa:
the restricting type and
the binge-eating/purging type
Binge eating:
out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances
purge
Remove the food they have eaten from their bodies (self-induced vomiting or misuse of laxatives, diuretics, and enemas)
___ percent of ballet students suffer from an eating disorder
20
Bulimia nervosa is characterized by…
uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise
DSM-5 Criteria for. . . Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eat-ing is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of
laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
The difference between a person with bulimia nervosa and a person with the binge-eating/purging type of anorexia nervosa is ____.
weight.
Binge-eating disorder (BED). BED has some clinical features in common with bulimia nervosa, except that
No compensatory behaviour follows the binge, and much less dietary restraint in BED.
DSM-5 Criteria for. . . Binge-Eating Disorder
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge-eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Anorexia nervosa and bulimia nervosa do not occur in
appreciable numbers before adolescence (T/F)
T
bulimia nervosa is most likely to develop in bAnorexia nervosa is most likely to develop in between the ages ofetween the ages of
21 - 24
People with binge eating disorder are generally between
30 - 50
more recent estimates suggest that there are ____females for every male with an eating disorder
three
more recent estimates suggest that there are ____females for every male with an eating disorder
three
One established risk factor for eating disorders in men is ______
homosexuality
The most common form of eating disorder is ______ and based on the most recent data, the lifetime prevalence of binge-eating disorder is around __ percent
binge eating disorder
2 (3.5% women in the US and 2% men)
higher in obese people (6.5 to 8%)
Worldwide, the prevalence of bulimia nervosa is estimated at ___ percent
1
The lifetime prevalence for _____ has gone down, while for ____ its gone up
bulimia nervosa
anorexia nervosa
The mortality rate for people with anorexia nervosa (most of whom are females) is more than ____ times higher than the mortality rate for young females ages 15 to 34 in the gen-eral U.S. population
five
Bulemia nervosa mortality rate is approximately _____ that found in people of comparable age in the general population
twice
. The most recent estimate from a meta-analysis suggests that individuals with anorexia nervosa are ____ times more likely to die by suicide than comparably aged women in the general population
18
Bulimia nervosa is not associated with increased risk of completed suicide, but suicide attempts are made in ___ to ____ percent of cases
25 to 30
____ percent of those with bulemia nervosa attain remission in the long-term
70
_____ percent of those with binge eating disorder attain remission after intensive treatment
60
transition to bulimia nervosa seems to occur for about __% after an earlier transition to the binge-eating/ purging subtype of anorexia nervosa
30
approximately 68 percent of patients with anorexia nervosa, 63 percent of patients with bulimia nervosa, and almost 50 percent of people with binge-eating diorder are also diagnosed with ______
depression
There is frequent co-occurrence of substance abuse disorders in the ______ subtype of anorexia nervosa as well as in ______ ______
binge-eating/purging
bulimia nervosa
Indeed, about ___ percent of women with eating disorders may have a personality dis-order
58
Personality disorders in the anxious-avoidant cluster (Cluster ___) are found in those with anorexia nervosa as well as those with bulimia nervosa, however, dramatic, emotional, or erratic (Cluster __) problems, including borderline personality disorder, are more typically associated with bulimia nervosa
C
B
Personality disorders are reported in around __percent of patients with BED. People with BED also have high rates of anxiety disorders (___ percent), mood disorders (___ percent), and substance use disorders (___ percent)
30
65
46
23
Addictive behavior is based on
the pathological need for a substance
Substance abuse generally involves an excessive use of a substance resulting in
(1) potentially hazardous behavior such as driving while intoxicated or
(2) continued use despite a persistent social, psychological, occupational, or health problem
Substance dependence includes more severe forms of substance use disorders and usually involves
a marked physiological need for increasing amounts of a substance to achieve the desired effects. Dependence in these disorders means that an individual will show a tolerance for a drug and/or experience withdrawal symptoms when the drug is unavailable
Tolerance
the need for increased amounts of a substance to achieve the desired effects—results from biochemical changes in the body that affect the rate of metabolism and elimination of the substance from the body.
Withdrawal refers to
physical symptoms such as sweating, tremors, and tension that accompany abstinence from a drug
heavy episodic drinking is defined as the
consumption of six or more alcoholic drinks on at least one occasion at least once per month
Approximately ___percent of people in the United States meet DSM criteria for alcohol use disorder at some point in their lifetime, and nearly 15 percent meet criteria in a given year
30
in 2015, more than _____ (___percent) of Americans ages 18 or older reported that they currently (i.e., in the past 30 days) drink alcohol and approximately a quarter (__percent) report binge drinking (i.e., having at least five drinks on one occasion in the past month
half 56 percent
27
The risk of alcohol use disorder is ___ as high in men than in women
twice
High consumption of alcohol inhibits which neurotransmitter
glutamate
DSM-5 Criteria for. . . Alcohol Use Disorder
A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
- Alcohol is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol. 5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued alcohol use despite having persistent or recur-rent social or interpersonal problems caused or exacer-bated by the effects of alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations in which it is physically hazardous.
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol. - Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499–500).
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid with-drawal symptoms.
In fact, from 15 to 30 percent of heavy drinkers develop _____of the liver, a disorder that involves extensive stiffening of the blood vessels in the liver.
cirrhosis
alcohol-induced psychotic disorders are marked by…
a temporary loss of contact with reality
Full blown symptoms of alcohol withdrawal delirium include (6):
(1) disorientation for time and place, in which, for example, a person may mistake the hospital for a church or jail, no longer recognize friends, or identify hospital attendants as old acquaintances;
(2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches;
(3) acute fear, in which these animals may change in form, size, or color in terrifying ways;
(4) extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested;
(5) marked tremors of the hands, tongue, and lips; and
(6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue, and foul breath.
___ per-cent of patients with alcohol withdrawal delirium die within 8 years of onset
30
alcohol amnestic disorder (Kosakoff’s)
Memory defect (often accompanies by falsified events)
Recognition issues
cortical lesions
judgment deficits
intellectual decline
Two important factors for addiction to a substance:
The first is the ability of most, if not all, addictive substances to activate areas of the brain that produce intrinsic pleasure and sometimes immediate, powerful reward
The second factor involves the person’s biological makeup, or constitution, including his or her genetic inheritance and the environmental influences (learning factors) that enter into the need to seek mind-altering substances to an increasing degree as use continues.
mesocorticolimbic dopamine pathway (MCLP) is the…
center of psychoactive drug activation in the brain.
Central to the neurochemical process underlying addiction is the role the drug plays in activating the “_______.”
pleasure pathway
for males, having one alcoholic X increased the rate of alcohol use disorder from 12.4 percent to 29.5 percent and having two such X increased the rate to 41.2 percent
For females with no X with alcohol use disorder, the rate was 5.0 percent; for those with one such parent, the rate was 9.5 percent; and for those with two X with alcohol use disorder, it was 25.0 percent
parent
children of parents whose parents had alcohol use disorder were nearly ____ as likely to have alcohol problems by their late 20s
twice
Specifically, alcohol-abusing parents are less likely to keep track of what their children are doing, and this lack of monitoring often leads to the adolescents’ affiliation with drug-using peers
In addition, s____ and _____ affect (more prevalent in families with a parent with an alcohol use disorder) are associated with alcohol use in adolescents. Extremely stressful childhood experiences such as ___ ____ or _____ _____ _____ might also make a person vulnerable to later problems.
stress and negative
physical abuse
child sexual abuse
Acohol abuse treatments
Antabuse
Treatment of withdrawal symptoms (Valium, benzo, diaz)
family counseling
community resources related to employment and other aspects of a person’s social readjustment (group therapy, environmental intervention, BT, AA, family groups, CBT)
Motivational interviewing (MI) is a brief intervention that was designed to be a major departure from earlier confrontational approaches in which a clinician suggested that the drinker stop consuming so much alcohol. in MI the clinician guides the patient through a…
collaborative conversation in which the patient articulates the pros and cons of drinking and ultimately makes a decision about whether she or he is motivated to change
A great strength of ___ is that it can be administered in one brief (35-minute) session and still have positive effects.
MI
A recent study found that relapse prevention (CBT) treatment worked most effectively when…
family members were involved in the treatment
2 Relapse related behaviours
“indulgent behaviors” based on an individual’s learning history. When an individual is abstinent or has an addiction under control, she or he gains a sense of personal control over the indulgent behavior. The longer the person is able to maintain this control, the greater the sense of achieve-ment—the self-efficacy or confidence—and the greater the chance that she or he will be able to cope with the addiction and maintain control
“abstinence violation effect,”
In relapse prevention treatment, clients are taught to
recognize the apparently irrelevant decisions that serve as early warning signals of the possibility of relapse.
Following alcohol, the psychoactive drugs most commonly associated with abuse and dependence in our society appear to be
(1) opiates, including opium and heroin;
(2) stimulants such as cocaine and amphetamines as well as caffeine and nicotine (disorders associated with tobacco
withdrawal and caffeine intoxication are included in the DSM-5 diagnostic classification system);
(3) sedatives such as barbiturates;
(4) hallucinogens such as LSD;
(5) antianxiety drugs such as benzodiazepines; and
(6) pain medications such as OxyContin
Opium is a mixture of about 18 chemical substances known as ________
alkaloids
When people addicted to opiates do not get another
dose of the drug within approximately ___hours of their last dose, they start to experience withdrawal symptoms
8
Withdrawal symptoms usually decline by the ___ or ___ day and by the seventh or eighth day have disappeared.
third or fourth
The dopamine theory of addiction suggests that addiction is…
the result of a dysfunction of the dopamine reward pathway
The reward deficiency syndrome hypothesis suggests that addiction is much more likely to occur in individuals who
have genetic deviations in components of the reward pathway, which leads them to be less satisfied by natural rewards
there is not a simple, single “pleasure pathway” in the brain. For instance, although dopaminergic pathways play a primary role in the “wanting” or anticipation of reward, it is the _____ system that seems to play a primary role in the “liking” or consumption of rewarding stimuli
opioid
70 percent of people who abuse opioids have o____ p_____ d_____, 50 percent have other forms of s_____ a_____, and 36 percent have a history of ________
other psychological diagnoses
substance abuse
trauma
____________ promises to be as effective a substitute for heroin as methadone but with fewer side effects
Buprenorphine
They found that children who were regularly exposed to _____ in utero were more likely to be mistreated (23 per-cent compared with only 4 percent of controls).
cocaine
There was no “fetal crack syndrome” similar to the syndrome associated with mothers who abuse _____
alcohol
drugs such as naltrex-one and methadone have been used to reduce _____use
cocaine
both CBT and C________ M_________ approaches are effective treatments for substance use disorders
contingency management (CM)
Contingency management is based on the principles of ______ ______ and offers rewards or financial incentives for meeting agreed-on treatment targets (e.g., drug-free urine). CM has been shown to be slightly more effective than CBT for cocaine dependence
operant conditioning
Methedrine is a far more potent stimulant of the CNS than either B____ or D____
Benzedrine or Dexedrine
People who are addicted to methamphetamine are highly resistant
to treatment, and posttreatment relapse is common, with approximately ______-____ relapsing within 6 months after treatment and ____relapsing during the next 3 years
one-third
half
Supporting the finding that nicotine may have an ________ property, nicotine use has been observed as being highly prevalent among those with ____ disorders
antianxiety
anxiety
Recent evidence from stroke-related brain injury suggests that ______ addiction might be controlled by a portion of the brain near the ear called the insula
nicotine
“tobacco withdrawal disorder,” (2)
(1) the daily use of nicotine for at least several weeks, and
(2) the presence of the following symptoms after nicotine ingestion is stopped or reduced: craving for nicotine; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain.
quit-smoking programs and nicotine replacement thereapy (NRT) enjoy only about a __ to ___ percent success rate on average, however, although rates have been reported to be higher with treatment
20 to 25
For over a hundred years, powerful sedatives called ______ have been available as an aid to falling asleep
barbiturates
With b________, withdrawal symptoms are more dangerous, severe, and long lasting than in o_____ withdrawal.
barbiturates
opiate
“flashback, an involuntary recurrence of perceptual distortions or hal-lucinations weeks or even months after an individual has taken the drug” relates to which drug?
LSD
_____works primarily by triggering the release of
large amounts of the neurotransmitter s_______and blocking its reuptake, leading to feelings of euphoria, energy, and well-being
Ecstasy
serotonin
Synthetic cathinones are substances that mimic the effects of ________ and _______by activating the body’s ______ system
amphetamines and cocaine
monoamine
DSM-5 Criteria for. . . Gambling Disorder
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
- Is restless or irritable when attempting to cut down or stop gambling.
- Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
- Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
- Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
- After losing money gambling, often returns another day to get even (“chasing” one’s losses).
- Lies to conceal the extent of involvement with gambling.
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
- Relies on others to provide money to relieve desperate financial situations caused by gambling.
B. The gambling behavior is not better explained by a manic episode.
Those with co-occurring ____ _____ disorders typically have the most severe gambling problems
substance abuse
evidence sometimes supports ____in treatment of gambling disorder
CBT
Although ____women exhibit levels of pathological eating similar to those of white women, it has long been held that ______ _______ are less susceptible to subclinical types of eating problems and body image concerns than Caucasians are.
Asian
African Americans
In one large family study of eating disorders, the risk of anorexia nervosa for the rela-tives of individuals with anorexia nervosa was ___.___ times greater than for the relatives of the healthy controls
11.4
For the relatives of people with bulimia nervosa, the risk of bulimia nervosa was __.__ times higher than it was for the relatives of the healthy controls
3.7
The relatives of people suffering from bulimia nervosa also have an increased likelihood of having problems with ___ and ___dependence while the relatives of those diagnosed with anorexia nervosa are at increased risk of ___ and ___
alcohol and drug dependence,
obsessive-compulsive disorder and obsessive-compulsive personality disorder
For example, high rates of ____ _____ _____ are found in the relatives of patients with anorexia nervosa, bulimia nervosa, and binge-eating disorder
major depressive disorder
This GWAS identified a locus (a specific position or location of a gene) for anorexia nervosa on chromosome ___, in a region that has previously shown associations with Type 1 diabetes and autoimmune disorders
12
This GWAS identified a locus (a specific position or location of a gene) for anorexia nervosa on chromosome ___, in a region that has previously shown associations with Type 1 diabetes and autoimmune disorders
12
Although still speculative at this time, it is reasonable to suggest that the hypothalamus “senses” weight in some way and keeps things in balance with the ventromedial hypothalamus acting as a “satiety center” and the lateral hypothalamus serving as an “appetite center.”
There is a well-established tendency for our bodies to resist marked variation from some sort of biologically determined ___ _____ or weight that our individual bodies try to “defend”
set point
neurotransmitter ___________ modulates appetite and feeding behaviour.
serotonin
Because many patients with eating disorders respond well to treatment with antidepressants (which target _____), some researchers have concluded that eating disorders involve a disruption in the _____ergic system
serotonin
seroton
People with anorexia nervosa have low levels of __-_____, which is a major metabolite of serotonin.
5-HIAA
more than one-third of patients with anorexia nervosa reported that family dys-function was a factor that contributed to the development of their eating disorder. Elaborate on ‘family dysfunction’ (3)
Patients with anorexia nervosa perceive their families as
more rigid,
less cohesive, and
as having poorer communication than healthy control participants do
_____X_____ also seems to predate disordered eating in those with anorexia nervosa, and remission does not lead to a reduction in _____X_____
perfectionism
negative affect is more likely to be the trigger for _______ ______, rather than the other way around
dietary restriction
Approximately ___ percent of patients with severe eating disorders have to be committed to a hospital for treatment against their will
17
Which subtype of anorexia nervosa is most likely to drop out of treatment?
binge/purge
research suggests that treatment of AN with an _______ medication called olanzapine may be beneficial.
antipsychotic
The best-studied approach, which (very importantly) blames neither the parents nor the child for the anorexia nervosa, is known as the ____ model
Maudsley model
According to RCTs, after 1 year of family therapy, ____ to ___ percent of AN patients show full recovery
75 to 90
For patients who are older or who have a long history of anorexia nervosa, the ________ approach unfortunately provides little clinical benefit
Maudsley
(CBT) has proved to be very effective in treating ____nervosa.
bulimia
In those with ______ nervosa, anti-depressants seem to decrease the frequency of binges as well as improve patients’ mood and preoccupation with shape and weight
bulimia
The findings therefore suggest that for racial and ethnic minorities with _____, interper-sonal psychotherapy might be a particularly suitable treat-ment approach
BED (Binge eating disorder)
BMI ranges:
18.5 are considered underweight;
18.5 to 24.9 is considered normal;
25.0 to 29.9 is overweight;
>= 30 is obese;
>=40 morbid obesity.
With the exception of _____, obesity is more prevalent in ethnic minorities.
Asians
In the U.S. less than a ____of the population is at a normal or healthy weight.
third
In general, rates of obesity are also somewhat higher in ____[gender] than they are in ____, except for which racial minority?
men
women
African Americans ( One in every two black women is obese)
a genetic mutation has been discovered that is specifically associated with binge eating in ___ percent of the obese population
5%
Only _____% of those without the binge-eating gene that were obese displayed a pattern of binge eating.
14%
Using _____approaches, researchers have now identified 97 genetic regions that are associated with body mass index and body fat distribution
GWAS
One key element of this homeostatic system is a hormone called _____, which is produced by fat cells.
leptin
People who are overweight generally have high levels of ______ in their bloodstream. The problem is that they are resistant to its effects.
leptin
Ghrelin (from hindu ‘growth’) is a hormone that is produced by the stomach. It is a powerful appetite _____.
stimulator
The food cravings experienced by people with _____-_____ syndrome can be so extreme that food has to be kept locked away so that they cannot binge
Prader–Willi
children ate __percent more after watching a TV cartoon that contained food advertisements than they did if the cartoon contained advertising for other products
45
Finally, there is some evidence that obesity might be “socially contagious.”
if someone close to us (e.g., a spouse, sibling, or friend) becomes obese, the chance that we ourselves will later become obese can increase by as much as __ percent.
57
research suggests that one pathway to binge eating may be through social pressure to conform to the ___ideal, as ironic as this may seem
thin
Three main treatment options are used with people who are overweight or obese:
(1) lifestyle modifications (diet, exercise, and behavior therapy),
(2) medications, and
(3) bariatric surgery.
Orlistat (Xenical) works by reducing the amount of fat in the diet that can be….
absorbed once it enters the gut.
Bariatric or gastric bypass surgery is the most effective long-term treatment for people who are _____ ______
morbidly obese
