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153 Cards in this Set
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What is the diagnostic criteria for bulimia?
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Objective binges on a large amount of food and subjective loss of control of what you were eating, with compensatory behaviors to counteract binge (purging and non-purging), no weight criterion (at or above normal weight, not immediately apparent that they suffer from eating disorder)
"binge-purge" cycle |
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How common is bulimia vs. anorexia?
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It is more commonly diagnosed
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What is an "objectively large amount of food"?
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Different for each person, gender
Can be like 1 cookie, but if someone feels subjectively out of control then it counts |
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What is a "subjective" loss of control?
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People like swimmers and teenage boys can eat a lot, like snack constantly or eat 50 bao, but they do not feel shame or guilt about it
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Where do emotional reactions get connected with?
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Emotional reactions are more related to compensatory behaviors
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What is purging/nonpurging compensatory behaviors?
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Purging - laxatives, throwing up
Non-purging - exercise, running for 5 hours |
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Do you need both binging and purging?
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YES
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What is Eating Disorder NOS?
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Eating disorder not otherwise specified.
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What are the three medical complications of bulimia?
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Dental problems, electrolyte imbalance and risk of death, and permanent damage to heart muscle and risk of death due to ipecac.
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How is depression different than eating disorders with respect to medical complications?
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Those with eating disorders are messing with food, causing more medical complications; being depressed doesn't cause serious medical problems.
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Why is bulimia a little more hidden than anorexia?
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Bulimics are at or slightly above normal weight so it's hard to tell
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How did Terry Schiavo get to a vegetative state?
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She was a bulimic and had a serious heart problem that made her die after years of chronic symptoms
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What is the bulimic cycle?
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Cycling from dieting/restrictions, to binge eating and feeling ashamed or guilty, to compensatory behaviors (purging and nonpurging).
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Is the bulimic cycle common?
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Very common in those with DSM-level bulimia
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How would someone start in the bulimia cycle? And how would someone be at risk for it?
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You would start at "dieting" and follow the circle around.
10% - at 12 30% at 16 50% at 20 75% at 20-30ish More common as people get older |
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How are people concerned with thinness in the first place?
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People can internalize the thin ideal, the extent to which an individual cognitively buys into socially defined ideals of attractiveness. This leads to body dissatisfcation and over-valuation of shape and appearance.
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What is internalization of the thin ideal?
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If that's the dominant media message, to what extent have you internalized it or separated it from what you believe or feel? Or, how likely do you incorporate this into your own standards?
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What is an example of a situation where you feel dissatisfied with your body and then evaluate your self negatively?
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If you are overweight, then you feel out of control. If you manage your weight, then you are good, strong, and disciplined.
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Who is at risk for developing internalization of thin ideal?
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Young, white, wealthy, sporty
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What study did they conduct to see how dietary restraint actually leads to binge eating?
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Dieters/Non-dieters given pre-load of milkshake/no pre-load, and people saw how much ice cream they ate later.
Outcome - Nondieters, ate more ice cream with no pre-load. Exact opposite problem for dieters. |
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What is counter-regulation?
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People who had high levels of dietary restraint given preload ate even more when given opportunity to eat anything than people without priming. (extra 200 calories)
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How biologically/evolutionarily become this way?
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In scavenging, when organisms finally got a food source, makes sense to eat a lot b/c food is scarce and body has gotten a message that it's time to eat
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When WWI healthy men were told to cut their diet, then remove it, what happened?
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These 40 year old men started having crazy episodes of binge eating
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When you diet and binge, you don't just eat more; what happens to the digestive tract?
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You have an increased digestive response also; your body's metabolic response to food goes up.
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How do you counteract binge eating?
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You have an experimental diet, like 3 meals and 3 snacks
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What are examples of cognitive processes of those with bulimia?
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Thoughts of no control (I'm not able to stop), permissive thoughts (I've already blown it; I may as well eat as much as I want), and lack of self-awareness (country candy wrappers).
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Why do people have thoughts of no control?
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They think that food controls them; they are unable to stop; period of restrictions and then binges -> automatic thoughts of "I have no control over this"
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If someone has more of these cognitive processes, this will __ the severity of the binging episodes
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increase
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What do permissive thoughts do?
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They perpetuate binging in the moment
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How can you counteract "lack of self-awareness" cognitive processes?
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Every time you open a wrapper, you ring a bell so that you can be aware of this
Tie tiny weights on hands, to decrease severity of binge Or be around a mirror, to decrease the severity of a binge Just pay more attention to body cues and what you feel like vs. just paying attention when the pain is excruciating |
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What are some common triggers for binging?
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Negative emotions, interpersonal conflict, intoxication, hunger, 'rule violation', being alone, and it being evening/night
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What is a 'rule violation'?
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For example, you might have a dietary restriction on pizza, yet at a party you eat it
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Why might being intoxicate trigger?
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Impulse control lower around food
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How is interpersonal/personal conflict a trigger?
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The way to deal with feeling sad, tired, lonely, angry, negative might be binging
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Why might be 1 reason that there is such a low male:female ratio of bulimia?
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Ovarian hormones
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What is the "social" answer to why girls are more vulnerable?
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There is a desire to be thin and diet and judge attractiveness more for girls than boys
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What is the "bio" answer to why girls are more vulnerable?
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If you track 9 twins and look at how much they ate and their ovarian hormones, can see at some points of cycle (like before menstruation) progesterone and see how they eat more
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Why is bio answer not enough?
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Yet that is not the whole picture - different social interactions and experiences work in concert
More binge eating than others -> not necessarily bulimic |
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What are characteristics of compensatory behaviors (purging)?
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They are highly negatively reinforcing, perpetuate restraint/binge cycle, and are socially contagious
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How is purging negative reinforcement?
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If you feel shame/guilt over binge-eating, then you purge to decrease the shame/guilt/physical discomfort
Difficult to unlearn this |
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What is social contagion?
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Lots of people hospitalized eating disorder girls together -> talk a lot about purging -> behavior jumping like wildfire through group
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What is the quasi experiment in Fiji?
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What effect did Western media have on adolescent girls?
Did comparison of 2 groups of 6/7th grade girls in remote villages Measured same grade and school 3 years later on disordered eating behaviors; same BMI, % households with TVs skyrocketed EMERGENCE OF SELF-INDUCED VOMITING Measured social contagion |
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What other evidence gives that bulimia is socially contagious?
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used to be considered a rare psychiatric disorder, now not uncommon
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What was her trigger and vulnerabilities?
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Mom passed away, not eating all day, stress of school and parenting
Bulimia -> way to control |
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After trigger and vulnerabilities, what happened next? (negative automatic thoughts)
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She had negative automatic thoughts where she thought she was a bad mom and employee; felt guilt and had broken food rule and had permissive thoughts
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How does she break through the lack of self awareness and how is it counteracted?
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Bell on fridge, yet counteracted by wine
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Usually how is trauma linked to bulimia?
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Usually distal trauma, more expering lots of negative affect
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What is the overwhleming emotion in bulimia?
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Shame about trauma and eating
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How does she use cognitive model?
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PIG thoughts, placing thoughts
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How to break the binge/purge cycle?
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Give away TV, have a regular meal plan, limit alcohol and intoxicants, identify situational and interpersonal triggers, increase self-awareness with daily monitors, and practice other ways to deal with loneliness, anger, sadness, and boredom
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Compared to bulimia, how rare is anorexia?
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It is much more rare.
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What is the diagnostic criteria for anorexia?
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Refusal to maintain body weight in a normal range (ex. 85%)
Intense fear of gaining weight even though skinny Body image distortion 3 times no period |
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What is the disadvantage of having periods?
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Pre-menarchial, people on birth control, men
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What are the 2 types of anorexia nervosa?
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Binge-eating/Purging type - binge, compensatory cycle in context of larger refusal to maintain normal body weight
Restrictive - not eating or exercising to not get calories |
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What kind of diagnostic crossover is there?
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Rare to go from bulimia -> restricting, but common to go from restricting anorexia -> binge-eating/purging anorexia -> bulimia
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What disorder has the highest mortality rate and medical complications? What are they?
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Anorexia (5% per decade of illness) - hair loss on head and lanugo on arms, face, torso, neck, osteoporosis (bone density stops after 24), impaired fertility (b/c no reason to maintain this if you don't have resources to have a baby), risk of heart failure, shrinking brain volume, erosion of teeth enamel, intestinal bleeding
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In the long-term, what happened to girls with anorexia?
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51% recovered, 16% dead
Half due to medical complications and half due to completed suicides (50x higher than general) 30% relapsed 30% binge eating 51-76% meeting criteria for "full recovery" at end of 15 year fellow-up 57-79 months time for recovery |
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Basically, what are the characteristics of anorexia in long term?
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It's serious, rare, chronic, and has high mortality/morbidity
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What did MN Starvation experiment do?
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See how little food people can get away with? Effects? how to most cost-effectively feed them?
20-30s conscientious objectors that were psychologically well 3 months - 3200 kcal per day, followed by 6-month semi-starvation period of 1800, then 3-month rehab period |
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What were the psychological effects of restricted diet?
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Memory loss, depression, irritability, fatigue, obsession with food, concentration on minute details: "notice everyhting is wrong", bothered by others' eating habits, impatient, guilt, introversion, less energy, dizziness, hair loss, ringing in ears, withdrew from class, no concentration, food became an obsession - eating took a long time, dowsed food with water to make it appear bigger. seeing boy on a bicycle, hating him,
People starving - psychologically not well-regulated Continually had food obsessions |
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Anorexic woman video - observations
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Started after parents divorced and mom had another partner, felt like had no say in anything, still weighs herself each day, even after 3 kids, and third kid born -> wanted to diet again, obsessed with apples right after she started to restrict diet again; food ritual of lining up apples
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Therapy for anorexia?
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First, get to a certain weight, and then start talk therapy.
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How do you have a regimented meal plan?
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NG tube/ PEG tube
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What is The Golden Cage?
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Large number of women w/ anorexia are coming from families that were dysfunctional
- caretaker parents, sexual abuse |
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What does anorexia have a high correlation with?
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OCD and perfectionism, rules
Difficult to treat b/c have both |
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What is sexual dysfunction?
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It is impaired desire for/ability to achieved sexual gratification
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What is the human sexual response?
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Desire - psychological, like want babies
Excitement - physiological Orgasm - climax, more components for women - more potential for dysfunctions Resolution - relaxing IN ALL - psychological component |
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What are mainly the problems of women/men SD?
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Women - lack of desire, arousal
Men - premature ejaculation, ED, lack of interest |
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What is hypoactive sexual desire disorder?
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It is having little or no sexual drive/interest; you don't want it
More psychological than biological More common for women |
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Why might it be more subjective to be diagnosed with HSDD?
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Treatments are different for say, 20 year olds and 60 year olds.
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What is sexual aversion?
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Sex = bad
Genital contact avoided at all costs Pretty rare |
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How might one get hypoactive sexual desire disorder? (HInt, what does it co-occur with?)
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SSRIs - reduce sexual desire; co-occurs with depression
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What treatments work for HSDD?
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Aphrodisiacs don't work (placebo effect)
Sensate focus therapy -> sexual touching without intercourse or orgasm as main goal (like don't need to have sex with orgasm) Cognitive restructuring to change dysfunctional sex beliefs using CBT; like change thought that "sex is all about having an orgasm" |
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What is erectile disorder?
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Can't obtain/maintain erection
Must be physiological or physiological/psychologically based |
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How might one get ED?
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Psychological - can do with themselves, but not with partner b/c if once didn't succeed -> felt too anxious -> felt anxious next time also (performance anxiety or cognitive distraction)
SSRIs Aging - vascular disease affects blood flow |
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What are some treatments for ED?
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Viagra - allowing blood flow
Pumps |
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What is female sexual arousal disorder?
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Females can't obtain/maintain vaginal swelling/lubrication (equivalent to men) - no arousal feelings or stimulation responses
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How can women get FSAD?
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They don't feel aroused or respond to stimulation
Or psychological - physiologically but not psych aroused Sex trauma SSRIs |
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How to treat FSAD?
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Same as HSDD
Sensate focus Cognitive restructuring Medications DO NOT WORK b/c may make a physical but not psychological difference (Viagra doesn't work) Psychotherapy - treatment for sexual trauma and reconstructing thoughts |
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What is premature ejaculation?
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Occurs after little stimulation (most common male sexual dysfunction)
Younger men "Premature" arbitrary - must consider age/sex activity |
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What is male orgasmic disorder?
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Inability to ejaculate during intercourse
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How can one treat PE?
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SSRIs
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How can one treat MOD?
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Not using SSRIs?
Cognitive reconstruction/CBT |
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What is female orgasmic disorder?
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Delay/inability to obtain orgasm despite normal phases; desiring it but can't get orgasm
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How does one get FOD?
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SSRIs
Anxiety CBT |
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What is vaginismus?
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Involuntary muscle spasm that blocks penetration; also more of a tension b/c maybe body not ready
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What is dyspareunia?
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Pain during intercourse (men and women), but not ncessarily sexual - can get from inserting tampon, even if you don't have sex
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How often do you need to binge eat to get diagnosis for binge eating disorder?
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2x/week for 3 months
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Is anorexia a culture bound syndrome?
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Probably not
Modern rates vs. rate of AN from 1812-1917 are the same Back then, called fasting girls/holy anorexics Observed in every non-Western culture How people view themselves not eating--"egosyntonic food refusal" or basically not seeing themselves with a problem even if everyone around them sees the problem |
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What is cultural about anorexia?
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Self-stated motivations
"Want to look like Kate Moss" "Don't want bloated stomach" "Like that I'm starving" MINN - not egosyntonic |
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Is bulimia a culture bound syndrome?
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Yes.
Don't see it in cultures except with exposure to Western media |
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Is distress necessary for anorexia?
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No, b/c don't need insight to have to qualify
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What is the diagnostic criteria for GID?
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A) Persistent cross-gender identification: repeated insistence that one is or wants to be the other sex, preference for clothing, make-believe, games, and playmates (less overtly), and verbal insistence "I want to be a girl"
B) Discomfort with sex or sense of inappropriateness of gender role - genitals disgusting, rejection of playmates, clothes, games, make-believe, and preoccupation with getting rid of secondary sex characteristics, coupled with people not identifying with own gender ex) wish I didn't have a penis, wish I looked like Mom rejection of things offered to child that are stereotypical |
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What makes something a disorder? + Debate abut GID?
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Like homosexuality debate?
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What are some other cultural attitudes to cross-gender behavior?
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Samoan Fa'afafine - "in the manner of women", the 3rd gender
Gender non-conformity but not gender dysphoria |
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What was 2 Families about?
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Zucker - suppose 4-year old black kid -> white? feel more comfortable about being black
Lonely picture? Vs. Other therapist - Homosexuality - electrical shock didn't work Freedom to be who they are Culture problems Not in business of coercing people; all kids come out worse |
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What is the most common outcome of childhood GID?
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Homosexuality without transsexualism (75%)
Adult transsexualism less frequent |
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What is the problem with statistics about long-term outcome?
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Small sample sizes
More boys than girls b/c boys -> that's more serious in their eyes? Time intensive Culture-dependent |
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What is the difference between transgender and transsexual?
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Transsexual - want to change gender
Transgender - don't want to change biological sex |
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What is sexuality for transsexuals?
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Homosexual (identify as heterosexual)
or Autogynephilic (identify as lesbian/gay) |
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What are medical treatments for transsexualism?
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Sex reassignment surgery is most effective treatment for gender dysphoria and cross-identification
87% successful outcomes of M->F, 97% successful outcomes of F-> M |
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What can hormonal treatments do?
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Delay puberty
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Controversies and problems of GID?
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GID - mental disorder or cultural problem?
Reparative therapy ethical? Adult transsexualism/homosexuality -> bad outcome? Medical treatments for transsexualism? Need a psychiatric diagnosis for sex reassignment surgery? |
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What did the Fa'fafine say in the video?
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Not transgender or crossgender as so much third gender
True to myself to overcome negativity Misinterpret who I am - not man in woman's clothing, or not man or woman; man roles, yet dress like women? Not mental disorder - don't relate to that Unique people, voice, no stigma, discrimination |
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How can Type A-ism be adaptive/not adaptive?
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Adaptive - get things done, so good for school; yet then you also freak out on people, get anxious and hostile - predictive validity for physical health
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What was the Western Collaborative Group Study?
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They followed men for 8.5 years and saw that those with Type A personality had 2x more coronary heart diseases and 8x more recurrent heart attacks, and an increase in hostility
Baseline-all healthy, no diagnosed chronic diseases |
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Why might hostility, not simply Type A in general, be implicated in more stress?
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Blood pressure skyrockets when hostile, making high levels of cortisol after stress
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What is happening in the model of the hypothalamic-pituitary-adrenal axis during stress?
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First, hypothalamus releases hormones (ACTH) that go to adrenal gland; cortisol goes from adrenal gland to hypothalamus in a negative feedback loop to shut off cortisol. Some cortisol from adrenal gland goes to immune system.
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How is stress response adaptive during fight or flight? How is it not adaptive?
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So you are prepped to fight or flight quickly; yet if feedback loop is disrupted, see in depressed people that cortisol isn't inhibiting hypothalamus, leads to symptoms of mental illness
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What are cytokines? How are they affected by cortisol?
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They are released by immune system, either pro-or anti-inflammatory
Cortisol throws pro and anti off balance More pro-inflammatory -> more vulnerability to sickness and infection b/c not operating in balance ex) exam time |
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How are cytokines and depression related?
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When have cold with flu or allergies, you feel like sleeping/doing nothing, withdrawing rom world, and not optimistic about future or social; same with depression!!
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How is social stress, depression associated with cytokines?
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Social stress -> higher IL-6
Social support -> lower IL-6 Depressed people -> higher IL-6 Give people IL-6 and produce sick behavior Treat MDD -> reduce IL-6!! |
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What did the Mental Health Parity and Addiction Equity Act of 2008 state?
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Everything related to biology; distinction between psychology/biology falling down
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What are the somatoform disorders?
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Bodily concerns and/or physical symptoms
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What are somatoform disorders?
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Bodily concerns and or physical symptoms that don't have a physiological basis; imagined but nothing; experience or express psychological distress as physical symptoms that are misinterpreted as illness
stomach ache -> stress physically there Includes hypochondriasis, somatization disorder, pain disorder, conversion disorder, body dysmorphic disorder |
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Where else can hypochondriasis fit into (DSM)?
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Anxiety disorders
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What is somatization disorder?
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Four pain symptoms in four bodily areas (head, back, abdomen, joints), two gastrointestinal symptoms (nausea, bloating, vomiting), one sexual symptom (sexual indifference, vomiting through pregnancy), one pseudoneurological symptom (loss of sensation, involuntary muscle contractions)
Laundry list of physical complaints that span entire body and unlikely to be caused by an organic disease Ex) seizures, but no abnormal electrical activity No neurological abnormality identifiable Hysteria by another name Very few people meet criteria for all of this; maybe sub-threshold |
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How common is somatization disorder?
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0.2-2.0% of the population; it is 3-10 times more common in women; it has an onset during adolescence
stereotype is that women who are physically ill are more pampered |
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What is hysterical neurosis?
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They thought somatization disorder was caused by the wandering uterus; then Freud said that they suffered from reminisces.
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What treatments did they give after Freudian view of hysteria?
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Hysteroctomy, marriage, avoiding intellectual or physical work, orgasms
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What is the current theory of why people develop somatization disorder?
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1) Manifestation of antisocial personality disorder in women
2) Misinterpretation of bodily sensations and secondary gain from sick role 3) "Real" physical abnormalities caused by psychosocial stressors |
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What is antisocial personality disorder and how does it relate to somatization?
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APD - disregard rules; psychopath; much less common in women; yet more convincing is probably that they have bodily sensations and misinterpret them and reduce activity
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What is misinterpreting bodily sensations and secondary gain from sick role + relation to somatization?
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Feel nervous -> misinterpret that there is a pain in stomach
Or get sick and don't go to lecture -> can get positively reinforced by people who care for you and not doing homework Cycle of having physical sensations, social support, love, attention, and reduction in responsibilities |
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How does "real" physical abnormalities relate to somatization?
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Makes sense for some symptoms, because you can make yourself feel nauseated or have muscle tension (not so much sense for paralysis and seizures)
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What is body dysmorphic disorder?
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Preoccupation with perceived or imagined flaws in appearance.
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How does BDD cause significant functional impairment?
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95% have complete social avoidance; 26^ admitted to psychiatric hospital; 25% have attempted suicide.
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What is the epidemiology of BDD?
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Equal rates of men and women; rare disorder-1-2% of the population; includes 8-20% of cosmetic surgery patients
Understudied and under-reported |
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Is BDD just a Western phenomenon?
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No; these are rates around the world
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What percentage of cosmetic surgery patients have BDD?
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8-20%
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How do people with BDD differ from transsexual people?
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After receiving plastic surgery, they are not more satisfed with themselves than before, whereas people who get a sex change are much happy and satisfied
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How do people maybe get BDD?
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Bullied, teased, or shunned as child; yet studies mainly retrospective.
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What is dissociation?
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Certain aspects of memory, identity, or perception are disrupted and occur outside of conscious awareness. Like many other disorders, this is experienced on a scale, with people with not very severe dissociation
Normative part of human experience - certain aspects of memory/perception wander off to somewhere off-conscious awareness |
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What are examples of dissociation?
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Driving car and drive 20 miles
Autopilot Reading |
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What is the criteria for DID?
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Presence of 2 or more distinct identities, each with its own relatively enduring pattern of perceiving, relating to, and thinking about self
At least 2 of the identities recurrently take control of the person's behavior Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness |
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What are the identites like in DID?
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Not fully-formed, sophisticated personalities. Splintered parts of identity
Ex) If I ask one of you, are you a nice person? Most of the class would ay yes. But if ask about conflicts--grab bag; doesn't mean you have DID, just that personality is broad; weave together a coherent narrative and multi-faceted idenitty as self Yet imagine instead that every time you are in a situation you behave differently, change voice and name; just 4 aspects of identity splintered off, taking turns being dominant; vs MPD |
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How is DID also a disorder of memory?
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Can't recall memories of last hours or minutes.
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What kind of memories are dysfunctional in dissociative identity disorder?
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Episodic and autobiographical, vs. semantic (forming English sentences), procedural (abilities of driving), and working memory intact
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How was the processing speed or general cognitive abilities of people with DID?
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Didn't change; like processing speed and cognitive abilities conserved; for example - wouldn't become a genius/lose genius ability
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What are some instances where people go through DID-like moments?
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Self-injurious - lose time, attempt suicide and have an episode of self-injury; no memory of doing anything however
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What are alters?
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Not personalities, but rather fragments of identity and conscious experience
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Why do people develop DID?
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To deal with stress and trauma
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What is the post-traumatic theory of DID?
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DID people use it as a psychological defense mechanism
Early sexual abuse Recovered memories of early trauma? Need to integrate? |
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Example of survivors of child abuse and DID?
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Survivors of child physical abuse say that they retreated from body and felt like they were watching whole thing from about of body or out of situation; checked out of what was going on--also heard interesting flip-flops between pronouns shifting from him/her instead of "i"
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What is repressed memories theory + DID? What is the problem with this?
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If happened b/c of trauma, if people don't remember trauma then must have had repressed memories of trauma
Yet might produce false memories |
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How does one uncover false recovered memories?
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Sociocognitive theory - lack of corroboration for "recovered memories" - more like hypnosis, leading questions, and suggestibility
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Why do people focus so much on recovering memories
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Freud - in case of Dora, weird sexual improprieties -> the cure was tracing back line of memory to accurately remember things she repressed
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What is the sociocognitive theory of DID, in more loose terms?
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"Disease caused by therapists"
People who go to therapists for DID sometimes create new alters and become more severe in DID experiences Responding to reinforcement, creating new alters rather than integrating them |
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What are experimental tests they did to test whether or not memory was disrupted between alters?
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Looked at cardiovascular response to traumatic memories in host vs. alter and saw differences in EEG patterns
ex) Told people to learn something under 1 identity, and recall it under another |
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How did they experimentally induce false memories?
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1) Told students of "spilling red punch down bride's dress and bride is crying" -> later, some participants induced false memory of rare event
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What was the Paul Ingram case?
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Suggested to daughters that he abused them but it wasn't true; just that therapists falsely engendered these memories in them
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What is the final conclusion about DID?
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Can't conclude much; some studies say that there's a clear difference in the way identities are formed, yet these studies have small Ns and not enough power
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How did they experimentally induce DID symptoms?
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Took college students and told them they were being interrogated for a minor crime; mimic DID study; people highly motivated vs. play acting
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How does literature by authors also not help for DID?
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See only a few authors writing papers; so maybe therapists' problems?
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