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178 Cards in this Set

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  • Back
What is anxiety?
A more general or diffuse emotional reaction (beyond simple fear) that is out of proportion to threats from the environment
What disorders are strongly comorbid with anxiety disorders?
- Depression; they are both often precipitated by stressful life events

- Panic attacks

- 50% of anxiety sufferers will have another mood or anxiety disorder

- 3x greater risk of alcohol disorder vs those without anxiety
What is agoraphobia?
Exaggerated fear of being in situations from which escape might be difficult or embarrassing, and results in avoidance and distress. E.g. being caught in a traffic jam or in a tunnel.
What is worry?
Relatively uncontrollable sequence of negative, emotional thoughts that are concerned with possible future threats of danger
What is panic, and how does it differ from anxiety?
A sudden, overwhelming experience of terror that is more intense, focused, and sudden than anxiety. Most think they are having a heart attack.
What is phobia?
Persistent and irrational fears associated with specific objects or situations leading to avoidance.
What are obsessions?
Repetitive, unwanted intrusive thoughts, images, or impulses that are unwelcome, and often aggressive or nonsensical.
What are compulsions?
Repetitive behaviors or rituals used to reduce anxiety that are considered to be senseless or irrational, eg counting, checking, cleaning
How can anxiety be adaptive?
It can help people prepare or mobilize for an upcoming event. Mild anxiety improves performance.
What is the difference between anxiety and worry?
Anxiety has physical symptoms and can be adaptive. Worry is strictly cognitive and is never helpful.
What happens if a panic attack occurs in response to a specific stimulus?
It is considered a phobia.
What is the difference between obsessions experienced by normal people, and clinical obsession?
Clinical obsessions differ in degree rather than nature; they last longer, occur more frequently, and are associated with higher levels of discomfort.
Why would people with panic disorder or agoraphobia avoid physical activity?
Their increased heart rate and breathing reminds them of the symptoms they experience in a panic situation.
What is the common fear among agoraphobics who do not experience panic?
This type of agoraphobia is seen in people with medical problems who are afraid no one will be around to help them.
What are some characteristics of panic disorder?
• Must have recurrent unexpected panic attacks
• At least one of the attacks has been followed by at least 1 month of ≥ 1 of the following:
– persistent concern about having additional attacks
– worry about the implications of the attack or its consequences
– a significant change in behavior related to the attacks
• Tendency to focus on and misinterpret internal cues
How does the learning model explain the development of phobic disorders?
Through classical conditioning, in which an originally neutral stimulus happened to be present during a traumatic experience.
What types of specific phobias exist?
– Animal (snakes)
– Natural environment (heights)
– Blood-injection-injury type (needles, blood)
– Situational type (flying)
How can phobias be evolutionarily advantageous?
- In the blood-injection injury type, heart rate and blood pressure are reduced, which would reduce the rate of bleeding

- One cannot be trained to be afraid of harmless things (like flowers)
What is social phobia?
Persistent and irrational fear of social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny.

Can be "generalized" when related to most social situations

Slightly more common in women
What is generalized anxiety disorder?
Excessive anxiety and worry (about multiple events and activities) are primary symptoms.

Also suffers from 3 or more of these symptoms:
– Easily fatigued
– Restlessness
– Difficulty concentrating
– Irritability
– Muscle tension
– Sleep disturbance
What is obsessive-compulsive disorder?
Must have either obsessions or compulsions, which the person recognizes are unreasonable.

The more a person tries to suppress a thought, the more prevalent it becomes. Checking momentarily relieves this anxiety, but reinforces OCD behavior in the long run.
What are "lumpers" and "splitters"?
Lumpers believe no distinctions should be made between anxiety disorders.

Splitters believe that anxiety disorders are all individual, with their own etiology.
What is the evolutionary theory about the the purpose of anxiety?
• Evolutionary: Anxiety might help us prepare/mobilize us
What social factors might contribute to anxiety?
• Social factors
– Stressful life events (PTSD)
– Childhood adversity (witnessing/being the victim of violence)
– Attachment relationships (John Bowlby said this is required)
What psychological factors might contribute to anxiety?
• Psychological factors
– Learning theory (fears may be classically conditioned)
– Cognitive factors (monkeys learning to fear snakes)
What biological factors might contribute to anxiety?
• Biological factors
– Genetic factors
• Panic disorder and GAD run in families
• Greatest genetic influence found for agoraphobia
• Least genetic influence for specific phobia
– Lactate injections (along w/ caffeine, can cause panic/anxiety attacks)
– Locus ceruleus (in brainstem; appears to be involved in worry & anxiety)
What are some exposure treatments for anxiety disorders?
- Systematic desensitization
- Flooding
- Interoceptive exposure (for panic): generate feelings associated w/ panic while in therapy & help client not catastrophize ("my heart is just beating fast")
- Exposure and response prevention (for germ phobes): Have person touch a door knob, but not wash hands. Need client's consent, but very effective.
What other treatments for anxiety exist?
- Cognitive therapy
- Pharmocological interventions: benzodiazepines, Buspar, tricyclic antidepressants or SSRIs.
What is the prevalence of anxiety disorders?
Anxiety is the most common mental disorder, and are broken down in the following percentages:

- Specific phobia: 9%
- Social phobia: 8%
- Agoraphobia w/o panic: 3%
- GAD: 3%
- Panic disorder: 2%
What are the gender differences in anxiety disorders?
Overall, 22.6% of women and 11.8% of men will have an anxiety disorder in the course of a year.

- Women are 3x more likely than men to develop specific phobias

- Women are 2x more likely than men to develop panic disorder, GAD, agoraphobia.

- Women are slightly more likely than men to develop social phobia

- OCD does not show a gender difference
What is the preparedness model?
Theory that the brain contains neural circuitry that is predisposed to quickly and unconsciously learning things that are evolutionarily advantageous, such as fears of snakes, spiders, and heights
How is dissociation defined?
A disruption of the normally integrated mental processes involved in memory, consciousness, identity, or perception
What are 3 dissociative symptoms?
• Depersonalization: "I felt like a robot going through the motions"
• Derealization
– sense of unreality about one’s self or the world: how people described 9/11
• dissociative amnesia
– Inability to recall important aspects of a traumatic experience: firefighters at WTC could not remember all events
What is Acute Stress Disorder?
• Person has been exposed to a traumatic event, in which the person experienced or witnessed that involved risk to themselves or others
• They responded with intense fear, helplessness or horror
• They have to have three of the following:
– Numbing
– Being in a daze
– Derealization
– Depersonalization
– Dissociative Amnesia
– Marked Avoidance
– Marked symptoms of anxiety or increased arousal ("jumpiness")
• Short term: lasts at least 2 days, not more than 4 weeks
What is Post Traumatic Stress Disorder?
• Person has been exposed to a traumatic event, in which the person experienced or witnessed that involved risk to themselves or others
• They responded with intense fear, helplessness or horror
• There are 3 categories of symptoms:
– Reexperiencing (need 1 symptom; thoughts, nightmares, flashbacks)
– Avoidance (need 3 symptoms; avoid people, places etc., or inability to recall aspects of the event)
– Increased arousal (need 2 symptoms; difficulty falling asleep, exaggerated startle response, etc.)
• Duration must be at least 1 month
What are some social factors in developing stress disorders?
Lack of support, e.g. the lack of support Vietnam vets received.
What are some biological factors in developing stress disorders?
Other mental health problems may put people at risk
What are some psychological factors in developing stress disorders?
Two-factor theory; classical conditioning creates fears, while operant conditioning reinforces them, e.g. avoidance reinforces the fear of a stimulus.
Which disorders are comorbid with PTSD?
Depression, anxiety disorders, and substance abuse.
What is the prevalence of PTSD?
About 8% of people in the U.S. will experience PTSD at some time in their lives.
What are five possible treatments for PTSD?
- For many, it will remit on its own (though faster with therapy)

- Cognitive Behavior therapy involving education (providing information), counseling (give coping strategies), exposure (systematic desensitization or flooding), assigning meaning out of the tragedy

- EMDR (eye movement desensitization and reprocessing) can be effective as long as it incorporates prolonged exposure

- CISD: group meeting where feelings are shared following a disaster, but some think it's detrimental because the emotional arousal may occur too soon

- Medication: SSRIs like Zoloft/Paxil are part of the "first line" of defense along with psychotherapy
Who conducted extensive research on the etiology and treatment of PTSD?
Edna Foa
What is a critical incident stress briefing?
CISD is a single 1 to 5 hour group meeting offered within 1 to 3 days following a disaster. No evidence yet that it reduces PTSD.
What is iatrogenesis?
The manufacture of dissociative disorders by their treatment.
What are the characteristics of dissociative fugue?
– Sudden onset
– Unexpected travel from natural environment
– Inability to recall one’s past
– Confusion about identity or assumption of a new identity
- Extremely rare
What is dissociative amnesia?
– Inability to recall important personal information, usually of a traumatic or stressful nature

- Not extremely unusual, memories may return
What is depersonalization disorder?
– Feeling detached, as if one is an outside observer of one’s mental processes or body

- Very rare, but can occur if the event is especially traumatizing
What are symptoms of dissociative identity disorder?
– The presence of 2 or more distinct identities or
personality states
– At least 2 of these identities take control of the
persons behavior
– Inability to recall important personal information
What are somatoform disorders?
Problems characterized by unusual physical symptoms that occur in the absence of a physical illness; psychological problems manifesting as physical ones.
What is somatization disorder?
– History of many physical complaints, beginning before age 30
– Lasts for several years
– Treatment sought; may undergo unnecessary invasive treatments
- Take up a lot of Dr.'s time
What is conversion disorder?
– Psychological conflicts are converted into physical symptoms like those found in neurological diseases or disorders
• E.g., hysterical blindness or paralysis
What is hypochondriasis?
– Preoccupation with fears that one has a serious disease

- "Worried well"; may reject good test results from the Dr.
What is pain disorder?
– Excessive preoccupation with pain that is motivated partly by psychological factors

- Don't realize that the pain isn't real
How can pain disorder be treated?
Family members are told to ignore pain talk, and reinforce non-pain talk
What is body dysmorphic disorder?
– Preoccupation with imagined defect in physical appearance, usually facial features
– Many visits to plastic surgeon; e.g. Michael Jackson
What is malingering?
– Pretending to have a disorder to obtain a tangible benefit, e.g. pretending to be disabled after a car accident to collect insurance $
What is factitious disorder?
– Feigned condition motivated by a desire to assume the sick role

- AKA Münchhausen's, or Münchhausen's by proxy.
What is the only somatoform disorder that isn't more common among women?
What treatment is available for somatoform disorders?
• Virtually no systematic research conducted on any treatment for somatoform disorders except behavior therapy
• Strong and consistent physician-patient relationship is important
• Physician should offer consistent emotional support and medical reassurance
What is a psychosomatic disorder?
An outdated term describing a disease caused by both psychological and physical factors. Now, every illness is viewed as a product of both mind and body.
What is stress?
A challenging life event that requires physiological, behavioral, or cognitive adaptation.
What is the SRSS?
Social Readjustment Rating Scale; assigns stress values to life events based on judgments of normal adults.
What are some criticisms of the stress ratings scales?
- Retrospective report
- Failure to distinguish positive and negative events
- Lack of consideration of individual differences
How did Richard Lazarus define stress?
An individual's appraisal of a life event.
What are the primary and secondary appraisals of stress?
Primary: Evaluation of the challenge/threat posed by the event.

Secondary: Appraisal of the abilities/resources available to cope with the event.
What is the fight or flight response?
An adaptive reaction to threat characterized by arousal of the sympathetic NS.
What part of the brain is involved in stress?
The amygdala
What hormones prepare the sympathetic NS for fight or flight?
The adrenal glands release epinephrine and cortisol.
Why is immune suppression adaptive?
The immune response (creates inflammation, fever, pain) impairs immediate action.
What is Selye's General Adaptation Syndrome?
3 stages:
- Alarm: mobilizes body
- Resistance: Body is activated and prepared to respond
- Exhaustion: Body's resources are depleted
What is problem-focused coping?
An attempt to change the stressor
What is emotion-focused coping?
An attempt to alter distress internally
What is an example of maladaptive emotion-focused coping?
What is the importance of predictability and control in stress?
- A signal before a stressor allows coping to occur before the onset of a stressor

- Control and the illusion of control alleviate stress
What can physical activity do for stress?
Serves as an outlet for frustration
What role does optimism play in stress and health?
Positive thinking is linked with better health habits and less illness in general.
What role does religion play in stress and health?
Improved health behavior
What role does following medical advice play in stress and health?
Stressors can interfere with adherence to medical recommendations.
What role does illness behavior play in stress and health?
Increased stress is correlated with increased physician visits and interference of pain in normal life.
What role does social support play in stress and health?
Improves immune, cardiovascular, and endocrine functioning
What role do psychological factors play in cancer?
- Health behaviors (like smoking) may be related to the development of cancer

- Structured, self-help groups improve quality of life and reduces physical effects, including death.
What role do psychological factors play in AIDS?
- High-risk behaviors associated with HIV infection

- Social support is important to well-being of patients; decreased social support related to more rapid onset of physical symptoms
What psychological techniques can treat pain?
- Hypnosis
- Biofeedback
- Relaxation training
- Cognitive therapy
What are the dyssomnias, and how are they defined?
- Difficulties in the amount, quality, or timing of sleep

- Insomnia, hypersomnia, narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder
What are the parasomnias, and how are they defined?
- Abnormal events that occur during sleep

- Nightmare disorder, sleep terror disorder, sleepwalking disorder

- Often associated with subclinical levels of anxiety and depression
What is cardiovascular disease (CVD)?
A group of disorders that affect the heart and circulatory system, including hypertension and coronary heart disease
What are 2 forms of coronary heart disease?
Angina pectoris and myocardial infarction
What effect does stress have on heart disease?
- Taxes the cardiovascular system through increased heart rate and blood pressure

- Heart may be damaged by constant stress
What is cardiovascular reactivity?
Increases in heart rate and blood pressure when exposed to stress
What effect does occupation have on heart disease?
Job strain as measured by high psychological demand and/or low decision control is related to increased rates of coronary heart disease.
What relationship does coronary heart disease and depression have?
Depression is 3 times more common among patients with coronary heart disease, and depression increases the risk for future cardiac events
What social factors influence the risk for cardiovascular disease?
- Friends and family can encourage a healthy lifestyle

- Interpersonal conflict can create anger which increases the risk of CHD

- Being married improves one's prognosis
What are beta blockers?
Reduce the risk of heart attack or sudden death following a cardiac episode.
What is the primary prevention for cardiovascular disease?
Improvement of health behavior, like quitting smoking, eating well, exercising, and monitoring blood pressure
What is the secondary prevention for cardiovascular disease?
Treatment of hypertension through health behavior and stress management
What is the tertiary prevention for cardiovascular disease?
Exercise and reduction of Type A behavior intended for those who have already suffered a cardiac event
What is the general definition of a personality disorder?
An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture.
What is affiliation and power, and how do they relate to personality disorders?
Affiliation: desire for close relationships with other people

Power: Desire for dominance, prestige, or impact

Symptoms of personality disorders relate to maladaptive variations of these needs
What is temperament?
A person's most basic, characteristic styles of relating to the world, evident in the first year of life.
What is the 5 factor model of personality?
Basic traits of personality including neuroticism (fearful, overly sensitive), extraversion (sociable), openness to experience, agreeableness, and conscientiousness (do the right thing)
What are Cluster A disorders?
Odd and eccentric individuals suffering from paranoid, schizoid, or schizotypal personality disorders.
What are Cluster B disorders?
Dramatic, emotional, or erratic individuals suffering from antisocial, borderline, histrionic, or narcissistic personality disorders
What are Cluster C disorders?
Anxious or fearful individuals suffering from avoidant, dependent, or obsessive-compulsive personality disorders
Describe paranoid personality disorder.
– A pervasive distrust and suspiciousness of others,
indicated by 4 or more of the following:
• Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
• Is preoccupied with unjustified doubts about the loyalty or
trustworthiness of others
• Is reluctant to confide in others
• Reads hidden threatening meanings into benign
• Persistently bears grudges
• Perceives attacks on character and is quick to react in anger
• Jealousy/suspicions of spouse or partner
What is the etiology of paranoid personality disorder?
- Object of excessive parental rage

- Uses defense mechanism of projection
What is the treatment of paranoid personality disorder?
- Don't enter treatment because they don't trust

- Supportive psychotherapy with a straightforward style
Describe schizoid personality disorder.
– Detachment from social relationships and
restricted emotional expression, as indicated by 4 or more of the following:
• Neither desires nor enjoys close relationships
• Almost always chooses solitary activities
• Has little interest in having sexual experiences with another person
• Takes pleasure in few activities
• Lacks close friends
• Appears indifferent to praise or criticism
• Shows emotional coldness, detachment, or flat
What is the etiology of schizoid personality disorder?
- Cold, negelctful, and ungratifying relationships in childhood
What is the treatment of schizoid personality disorder?
- Cognitive-behavioral approach used to increase social interaction
Describe schizotypal personality disorder.
– Social and interpersonal deficits marked by acute
discomfort with close relationships and by cognitive or perceptual distortions and
eccentricities, indicated by 5 or more:
• Ideas of reference
• Odd beliefs or magical thinking
• Unusual perceptual experiences
• Odd thinking and speech
• Suspiciousness or paranoid ideation
• Inappropriate or constricted affect
• Behavior or appearance that is odd, eccentric, or peculiar
What is the etiology of schizotypal personality disorder?
• Schizophrenia spectrum disorder
• This PD is most strongly related to familial schizophrenia
• Increased dopaminergic functions
What is the treatment for schizotypal personality disorder?
Low-dose antipsychotic medication
How does one distinguish between schizoid and schizotypal personality disorders?
Schizotypal is typified by odd/magical thinking, e.g. "It rained today because of me".
Describe antisocial personality disorder.
– Disregard for and violation of the rights of
others, indicated by 3 or more of the following:
• Failure to conform to social norms repeatedly
• Deceitfulness
• Impulsivity or failure to plan ahead
• Irritability and aggressiveness (physical fights)
• Reckless disregard for the safety of others
• Consistent irresponsibility
• Lack of remorse
What are biological factors in developing antisocial personality disorder?
- Interaction between biological and environmental factors
What are social factors in developing antisocial personality disorder?
- Children with a difficult temperament may annoy their caretakers, who subsequently abuse them, but the child resists disciplinary efforts

- Poor social skills

- Befriending others with similar traits
What are psychological factors in developing antisocial personality disorder?
Psychopaths may have an emotional deficit, as studies on their reduced startle response, and inattentiveness to negative consequences have shown
What is the best predictor of adult antisocial personality disorder?
Conduct disorder in childhood
What is the difference between psychopathology and antisocial personality disorder?
- Psychopathology emphasizes emotional deficits and personality traits, and is difficult to use reliably.

- ASPD places emphasis on observable behaviors and conflict with authorities and unlawful behavior.
Describe borderline personality disorder.
– Pervasive pattern of instability in mood and interpersonal
relationships, indicated by 5 or more of the following:
• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable and intense interpersonal relationships
characterized by splitting
• Identity disturbance: unstable self-image
• Impulsivity in at least two areas that are potentially selfdamaging
• Recurrent suicidal behavior, gestures, or threats of selfmutilation
• Affective instability due to marked reactivity of mood
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger
What is the etiology of borderline personality disorder?
• Inattention to child’s emotions and attitudes
• High frequency of traumatic early
abandonment, physical abuse, and/or sexual abuse
• Evidence of serotonergic involvement
What are some treatments for borderline personality disorder?
- Dialectical behavior therapy; placing contradictory ideas side by side

- Any psychoactive medication
Describe histrionic personality disorder.
– Excessive emotionality and attention seeking, indicated
by 5 or more of the following:
• is uncomfortable in situations in which he or she is not the
center of attention
• interaction with others is often characterized by
inappropriate sexually seductive or provocative behavior
• displays rapidly shifting and shallow expression of
• consistently uses physical appearance to draw attention to
• has a style of speech that is excessively impressionistic
and lacking in detail
• shows self-dramatization, theatricality, and exaggerated
expression of emotion
• is suggestible
• considers relationships to be more intimate than they
What is the etiology for histrionic personality disorder?
Emotional expressiveness,
attention seeking can be extreme
variations of temperamental dispositions
What is the treatment for histrionic personality disorder?
• How their self-esteem is maladaptively tied to their ability to attract attention at the expense of developing other skills
• How their shallow relationships and emotional experience reflects unconscious fears of real committment
Which personality disorders may histrionic personality disorder be linked with?
Borderline; both are intensely emotional and manipulative
Describe narcissistic personality disorder.
– Grandiosity, need for admiration, and lack of empathy,
indicated by 5 or more of the following:
• has a grandiose sense of self-importance
• is preoccupied with fantasies of unlimited success,
power, brilliance, beauty, or ideal love
• believes that he or she is "special" and unique and can
only be understood by, or should associate with, other
special or high-status people (or institutions)
• requires excessive admiration
• has a sense of entitlement
• is interpersonally exploitative
• lacks empathy
• is often envious of others or believes that others are
envious of him or her
• shows arrogant, haughty behaviors or attitudes
What is the etiology for narcissistic personality disorder?
Little evidence available for etiology
What is the treatment for narcissistic personality disorder?
• Psychotherapy addresses person’s reactions to frustrations and disappointments
Which age and gender tends to meet the diagnostic criteria for narcissistic PD?
• Common in adolescence
• 50-75% male
With which personality disorder does narcissistic personality disorder overlap?
Borderline; both involve feelings that others should recognize their needs and do special favors for them
Describe avoidant personality disorder.
– Social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation, indicated by 4 or
more of the following:
• avoids occupational activities that involve significant
interpersonal contact, because of fears of criticism,
disapproval, or rejection
• is unwilling to get involved with people unless certain of being
• shows restraint within intimate relationships because of the
fear of being shamed or ridiculed
• is preoccupied with being criticized or rejected in social
• is inhibited in new interpersonal situations because of feelings
of inadequacy
• views self as socially inept, personally unappealing, or inferior
to others
What is the etiology of avoidant personality disorder?
Parental rejection and censure
What is the treatment of avoidant personality disorder?
• Supportive psychotherapy
• Assertiveness and social skills
• Anti-anxiety medication
Which diagnosis is similar to avoidant personality disorder?
Generalized social phobia
Describe dependent personality disorder.
– Need to be taken care of that leads to submissive and clinging behavior and fears of separation, indicated by 5 or more of the following:
• has difficulty making everyday decisions without an excessive amount of advice
and reassurance from others
• needs others to assume responsibility for most major areas of his or her life
• has difficulty expressing disagreement with others because of fear of loss of
support or approval.
• has difficulty initiating projects or doing things on his or her own
• goes to excessive lengths to obtain nurturance and support from others
• feels uncomfortable or helpless when alone because of exaggerated fears of
being unable to care for himself or herself
• urgently seeks another relationship as a source of care and support when a
close relationship ends
• is unrealistically preoccupied with fears of being left to take care of himself or herself
What is the etiology of dependent personality disorder?
An exaggerated and maladaptive
variant of normal dependency
What is the treatment of dependent personality disorder?
Cognitive-behavioral therapy that encourages independence
Describe obsessive-compulsive personality disorder.
– Preoccupation with orderliness, perfectionism, and
mental and interpersonal control, at the expense of
flexibility, openness, and efficiency, as indicated by
four (or more) of the following:
• is preoccupied with details, rules, order, or schedules to
the extent that the major point of the activity is lost
• shows perfectionism that interferes with task completion
• is excessively devoted to work and productivity to the
exclusion of leisure activities and friendships
• is overconscientious and inflexible about matters of
• is unable to discard worn-out or worthless objects even
when they have no sentimental value
• is reluctant to delegate tasks or to work with others
• adopts a miserly spending style toward both self and
How is obsessive-compulsive personality disorder different from OCD?
OCPD is defined by personality traits such as excessive conscientiousness, whereas OCD involves intrusion of unwanted thoughts and ritualistic behavior.
What is the treatment of obsessive-compulsive personality disorder?
• Difficult to treat because of excessive intellectualization and difficulty expressing emotion
• Cognitive techniques may also be helpful in diminishing patients’ need for control
and perfection
Which disorders are those with obsessive-compulsive personality disorder at risk for?
Generalized anxiety disorder, panic disorder, and OCD.
What are some criticisms of the DSM's classification of personality disorders?
- Implies sharp boundaries between normal and abnormal behavior

- Considerable overlap among categories.
What is the prevalence of Axis II disorders?
Lifetime prevalence = 10-14%
What is the most common personality disorder?
Obsessive-compulsive personality disorder, although borderline seeks the most treatment, and dependent is most frequently reported in mental health clinics
What is the rate of overlap for personality disorders?
At least 50% of people who meet the criteria for a personality disorder also meet criteria for another disorder.
What are gender differences in the prevalence for personality disorders?
Antisocial, paranoid, schizoid, narcissistic, obsessive-compulsive personality disorders affect men more.
Which personality disorder has the highest rate of recovery following treatment?
Borderline personality disorder
What is "splitting", as it relates to borderline personality disorder?
Tendency to view people and events alternately as entirely good or entirely bad.
Which personality disorders are associated with childhood maltreatment?
- Mostly Cluster B disorders

- Physical abuse = ASPD
- Sexual = borderline, narcissistic, and avoidant
Why is treatment of personality disorders difficult?
- People with the disorders don't have insight into their problems and don't seek treatment

- Pure forms of personality disorder are rare, and tend to be comorbid with other PDs, or Axis I problems

- People with these disorders have difficulty establishing meaningful relationships like those required for psychotherapy
What is an eating disorder?
Severe disturbances in eating behavior that result from the sufferer’s obsessive fear of gaining weight
What is anorexia?
– Defining characteristic is emaciation
– Literal meaning is loss of appetite
– Refusal to maintain body weight at or above a minimally normal weight for age and height
– Intense fear of gaining weight or becoming fat, even though underweight
– Disturbance in the way in which one’s weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
– In postmenarcheal females, amenorrhea
What subtypes exist for anorexia nervosa?
– Restricting type – person has not regularly engaged in binge eating or purging

– Binge-eating/purging type – person has regularly engaged in binge eating or purging behavior
What is bulimia?
– Binges followed by compensatory behavior (e.g.,
vomiting, taking laxatives)
– Literal meaning is ox appetite
– Recurrent inappropriate compensatory behavior in order to prevent weight gain, such
as self-induced vomiting; misuse of laxatives,
diuretics, enemas, or other medications;
fasting; or excessive exercise
– The binge and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
– Self-evaluation is unduly influenced by body shape and weight
– The disturbance does not occur extensively during episodes of Anorexia Nervosa
What subtypes of bulimia nervosa exist?
– Purging type – person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
– Nonpurging type – person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
What medical complications are related to anorexia nervosa?
- Constipation, abdominal pain, intolerance to cold, lethargy, some of which may be due to lowered blood pressure and body temperature.

- Dry, cracked skin

- Development of lanugo (fine, downy hair) over face and body

- Anemia

- Infertility

- Impaired kidney functioning

- Cardiovascular difficulties

- Dental erosion

- Osteopenia (bone loss)

- Electrolyte imbalance
What disorders are comorbid with anorexia nervosa?
Obsessive compulsive disorder, obsessive compulsive personality disorder, depression
What is binging?
• Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
• A sense of lack of control over eating during the episode
What disorders are comorbid with bulimia nervosa?
Depression, anxiety disorders, personality disorders (esp. borderline), substance abuse (esp. alcohol/stimulants)
What medical complications are related to bulimia nervosa?
– Erosion of dental enamel
– Unintentional gag reflex  rumination (regurgitation and rechewing of food)
– Enlargement of salivary glands
– Electrolyte imbalance
– Rupture of esophagus or stomach
When did the prevalence of anorexia and bulimia increase?
1960s and 1970s
Which eating disorder is more common?
Bulimia nervosa
What social factors contribute to eating disorders?
- Cultural standards of beauty
- Internalization of those ideals
- Troubled family relationships
Which disorder is more influenced by cultural ideals?
Bulimia nervosa
What family dynamic contributes to anorexia?
Cohesive family unit, enmeshed (overly involved) family members. Anorexia is an attempt to control one thing about one's life
What family dynamic contributes to bulimia?
- Conflict and rejection
What psychological issues contribute to eating disorders?
- Struggle for perfection and control
- Conforming and eager to please
- Depression, low self-esteem
- Negative body image
- Dietary restraint
What is interoceptive awareness?
Recognition of internal cues, including various emotional states and hunger
What may trigger a binge in bulimia nervosa or the binge subtype of anorexia nervosa?
Dysphoria (negative mood states) commonly trigger episodes of binge eating.
What is a weight set point?
A fixed weight that the body strivers to maintain
What biological factors contribute to eating disorders?
- As weight declines, metabolism slows, and hyperlipogenesis occurs (storage of abnormally large amounts of fat in fat cells).

- Genetics play a role as MZ twins have higher concordance rates for eating disorders and dysfunctional eating attitudes.

- High levels of endogenous opioids, low serotonin, diminished neuroendocrine functioning
What treatments exist for anorexia nervosa?
Treatment focuses on 2 goals:

- Help the patient gain at least a minimal amount of weight
• Inpatient setting
– Coercive methods
– Strict behavior therapy programs where rewards are
contingent on weight gain

- Therapy to address the difficulties maintaining the disorder
• Family therapy
– Structural family therapy
• Individual therapy
– Bruch’s modified psychodynamic therapy
– Cognitive-behavioral therapy
– Feminist therapies
What is the course and outcome for anorexia nervosa?
– Treatments not very effective
• 50-60% normal weight
• 10-20% significantly underweight
• Remainder intermediate in weight
• 10% starve themselves to death or die of
related complications
– More than half continue to have difficulties
with eating; preoccupation with diet, weight, and body shape
What treatments exist for bulimia nervosa?
– Antidepressant medications
• All classes are effective however medication alone not best treatment

– Cognitive-behavioral therapy
• Stage 1: education and behavioral strategies to
normalize eating patterns & identify precursors to binging
• Stage 2: addressing broader, dysfunctional
beliefs about self, appearance, and dieting
• Stage 3: consolidating gains and preparing
strategies for coping with expected relapses in
the future
• 70% reduction in in binge eating and purging

– Interpersonal psychotherapy
• Does not focus on eating disorder but on
difficulties in close relationships
• Thought to work because interpersonal
problems are associated with bulimia nervosa
What is the course and outcome for bulimia nervosa?
– Outcome generally more positive than for anorexia nervosa
– Most maintain a normal weight
– Mortality rare
– Comorbid psychological disorders tend to improve with improvements in bulimia nervosa
– Very little known though about natural course
What is anorexia athletica?
• Necessary features:
– Weight loss – more than 5% of expected body weight
– Gastrointestinal complaints
– Absences of medical illness or affective disorder explaining the weight reduction
– Excessive fear of becoming obese
– Restriction of caloric intake – diets at or below 1200 calories
What are common features of anorexia athletica?
– Delayed puberty – no menstrual period at age 16
– Menstrual dysfunction – amenorrhea
– Disturbance in body image
– Use of purging methods (e.g., vomiting,
laxatives, diuretics)
– Binge eating
– Compulsive exercising