Abnormal Psych Tulane Final Chapter 8

Front 1

Bulimia

Back 1

1) Bulimia Nervosa: Eating within a discrete period of time more food than typical for most others during a similar period of time and under similar circumstances
(i) A sense of lack of control over eating/ the feeling that one cannot stop
 Must binge 2 times/month for 3 months to be diagnosed
(ii) Recurring inappropriate compensatory behavior in an effort to prevent weight gain
 Includes: vomiting, misuse of laxatives, diuretics, medications, excessive exercise, or fasting
(iii) Their “self-evaluation” is unduly influenced by their body shape/ weight
 Normally bulimics are within about 10 lbs of a normal weight, but see themselves as much heavier

Front 2

Purging Techniques

Back 2

(i) Vomiting
 Reduces about 50% of calories
(ii) Laxatives and diuretics are ineffective in reducing calories
(iii) Excessive exercise often increases appetite
(iv) Development of more body fat is common
(v) Many health problems
 Eroded tooth enamel, electrolyte imbalance leading to fatal conditions, cardiac arrhythmia, seizures, renal failure, use of laxatives can have permanent damage to colon

Front 3

Bulimia Co morbidity

Back 3

(i) Higher rates of anxiety and mood disorder
 Question of what comes first; depression or bulimia?
 Substance abuse found in approx. 33% of samples
• Both alcohol and drug use

Front 4

Anorexia Nervosa

Back 4

(i) Refusal to maintain body weight at or above a minimal normal weight for age and height
 Less than 85% of expected weight
(ii) Intense fear of gaining weight or becoming fat, even though the person is under weight
(iii) Disturbance in the way that one’s weight or body shape is experienced, evaluated, and/or denial of seriousness about significantly low weight
(iv) In post-menarcheal females, absence of at least 3 menstrual cycles
 “Amenorrhea”
(v) Types: Restricting or Binge-eating with purging

Front 5

Characteristics of Anorexia Nervosa

Back 5

(b) Characteristics
(i) Decreased body weight is the most obvious
(ii) Begins with perception of being overweight
 Diet escalates to obsessive level and attention to daily weight changes is painful
 Focus on different parts of the body
 Some become obsessed with cooking or hoarding food that they do not eat

Front 6

Binge eating

Back 6

1) Recurrent episodes of binge eating
(a) Associated with 3 or more: unusally rapid eating, eating large amounts without physical hunger, eating until uncomfortably full, eating alone because of embarrassment, feelings of self-disgust, depression, or sever guilt after episodes
(b) Significant distress
(c) Must occur 1 time/week for 3 months for diagnoses
(d) No pattern of inappropriate compensatory behaviors

Front 7

Physical Consequences of Purging

Back 7

1) Physical Impact
(a) Amenorrhea may or may not occur
(b) Binging: same as Bulimia Nervosa
(c) Lanugo or downy hair on the body, brittle hair or nails, dry skin, sensitivity to cold
(d) Aches and pains with movement, walking, lying down
(i) Cardiovascular problems such as chronically low blood pressure and heart rate

Front 8

The Causes of Eating Disorders (Social and Psychological)

Back 8

1) Social
(a) “nothing tastes as good as thin feels,” the idea that thin is more important than health
(b) Influences
(i) Friend groups
(ii) Parental attitudes about eating
 Parental attitudes about dieting
 Family dynamics of avoiding conflict and an unwillingness to deal with negative emotion
 Mothers model dieting and food restriction
(c) Media and Models
(i) Distortions in body image
(d) Social pressures associated with certain activities
2) Biological
(a) Certain genes contribute
(b) Low levels of serotonin (depression/ OCD)
(c) Hypothalamus (regulates body functions)
(i) Lateral hypothalamus: increases hunger when stimulated
(ii) Ventromedial hypothalamus: reduces hunger when stimulated
3) Psychological
(a) Might run in families
(i) Higher incidences if other anxiety and mood disorders run in the family
(b) Diminished sense of personal control
(i) Poor confidence in personal abilities and talent
(ii) Diificulty tolerating negative emotions
(c) Women’s roles general less fl

Front 9

Effective Treatments for Eating disorders

Back 9

1) Drug Treatment: Generally ineffective, though some antidepressants show promise in treating Bulimia
2) Cognitive behavioral therapy treatment to change attitudes about body and eating
(a) Bulimia needs psycho-educational interventions
(i) Cognitive therapy for dysfunctional thoughts
(ii) Family therapy, cognitive behavioral therapy, or both
(b) Binge eating disorder: Cognitive behavioral therapy/ interpersonal therapy are equally effective
(c) Anorexia: inpatient treatment is recommended if the patient is <85% of their expected body weight (if their condition is life threating)
(i) Family therapy, cognitive behavioral therapy, or both
(ii) Long term treatment is needed as relapse is common

Front 10

Obesity

Back 10

1) Obesity: an excessive proportion of total body fat
(a) A person is considered obese when his weight is 20% or more above normal weight. The most common measure of obesity is the body mass index/ BMI
(b) A person is considered overweight if his or her BMI is between 25 and 29.9
(i) A person is considered obese if his BMI is over 30
(c) Morbid Obesity: a person is either 50-100% over normal weight, more than 100 pounds over normal weight, has a BMI of 40 or higher, OR is sufficiently overweight to severely interfere with health or normal function
2) Not considered an eating disorder under the DSM
(a) US epidemic
(i) 35.7% are obese and the percentage is increasing
(ii) Obesity related conditions include: heart disease, stroke, type 2 diabetes, certain types of cancer, and one of the leading causes of preventable death
(iii) In 2008, medical costs associated with obesity were estimated at $147 billion
 91% of US healthcare costs
 The medical costs for people who are obese were $1,42

Front 11

Negative Effects of Obesity

Back 11

3) Negative Effects
(a) Lower life expectancy, Fewer employment opportunities, bone problems, deep vein thrombosis, hernia, cancer, joint problems, low self-esteem, heart attacks, depression, breathing problems, high blood pressure, type 2 diabetes, increased sweating, high cholesterol, social discrimination, arthritis

Front 12

Stats with Obesity

Back 12

(a) Non-hispanic Blacks have the highest age adjusted rates of obesity (49.5%) compared with Mexican Americans (40.4%), all Hispanics (39.1%), and non-Hispanic whites
(b) Among non-Hispanic Black and Mexican-American men, those with higher incomes are more likely to be obese than those with low income
(i) Higher income women are less likely to be obese than low-income women
(c) There is no significant relationship between obesity and education among men
(i) Among women, those with college degrees are less likely to be obese compared with less educated women

Front 13

Dysfunctional Pattern of Eating

Back 13

(a) Night Eating Syndrome: Consume more than a third of their daily requirements after their evening meal and often get up during the night for high calorie snack.
(i) Not hungry in the morning—food intake in the mornings is negligible
(b) Binge Eating: about 7-19% of people eat large amounts of food at one time

Front 14

Causes of obesity

Back 14

(a) Generally cultural
(i) More sedentary lifestyle, consumption of high fat, energy dense diet, large portions
(ii) Toxic environment
 Unpleasant interactions, difficult relationships
(iii) Emotional
 Use food as emotional regulation/ “comfort foods”
 Impulse control
 Attitudes/ motivation towards eating
 Close ties such as friendships with obese people
(b) Genetic Predisposition
(i) 30%
(ii) Some people with the same lifestyles become obese when others do not

Front 15

Treatment of Obesity

Back 15

(a) Earlier intervention is more effective
(i) Lifestyle changes must be the basis of weight loss
 Relapse is common
(ii) People will try anything to lose weight
 Self-help, commercial plans, medically-guided weight loss programs, bariatric surgery (risky)
(iii) Dangerously obese people (about 5% of the US population) have to engage in significantly structured and restrictive programs that change lifestyles
 Approx. 15% of those who have bariatric surgery fail to lose significant weight or regain the weight initially lost

Front 16

Sleep Disorders

Back 16

1) Sleep Disorder: Persistent or reoccurring sleep related problems that cause distress or impaired functioning
(a) Dysomnias: Difficulties getting enough sleep, problems getting to sleep, or having sleep that is of poor quality
(i) Amount, quality, or timing of sleep
(b) Parasomnias: Sleep is disrupted by abnormal behaviors of physiological events such as nightmares or sleeping walking

Front 17

Insomnia

Back 17

1) Insomnia: Trouble falling asleep, staying asleep (wake during the night and cannot go back to sleep; wake up too early), or nonrestorative sleep
(a) Primary Insomnia: Not related to medical or psychological problems
(i) Most people experience insomnia during times of stress
 Aprox 1/3 of US in a given year
(c) Learned Behavior
(i) There are many indicators that poor sleep is created through bad habits, but there is a lack of conclusive research

Front 18

Stats with Insomnia

Back 18

(b) Statistics
(i) Psychological disorders associated with insomnia: mood disorders, susbstance use disorders, anxiety disorders, and Alzheimer’s
(ii) Women report more insomnia than men
(iii) High rates of insomnia among children
 25-40%
(iv) High rates among teens
(v) More ¼ of older adults 55-64
(vi) 21% of those over 65

Front 19

Primary Hypersomnia

Back 19

: Sleeping too much
(a) Sleep all night, appear rested when awakened in the morning, but fall asleep during the day
(i) Must rule out other potential causes like sleep apnea (difficulty breathing at night), insomnia, and other psychical and psychological considerations

Front 20

Narcolepsy

Back 20

: Includes both daytime sleepiness and cataplexy (the person is awake, experiences strong emotion, loses muscle tone, and immediately falls into REM sleep)
(a) Rare
(b) Those afflicted also report sleep paralysis (brief period where they are awake but cannot move or speak)
(i) Hypnagogic Hallucinations: Vivid and terrifying experiences at the beginning of sleep
 Very realistic and include visual, tactile, hearing, and sensations of body movement
• Often believe someone is in the room that there is a serious threat to their safety

Front 21

Breathing Related Sleep Disorders

Back 21

4) Breathing Related Sleep Disorders: Sleep disruption due to sleep-related breathing problems to excessive sleepiness or insomnia
(a) Apnea
(i) Obstructive: airflow stops despite continued activity by the respiratory system
 Narrow airway, abnormality, or damage
• Affected by age, obesity, use of drugs such as ecstasy
• 10-20% of U.S. population
• More males affected
(ii) Central: Complete cessation of breathing associated with damage to the central nervous system. Stops breathing and then wakes up frequently. Tends not to be reported, and the person is often unaware
 Not well studied
(iii) Mixed: Combination of obstructive and central

Front 22

Nightmare Disorder

Back 22

repeated awakenings from a major sleep period with a detailed recall of extended and extremely frightening dreams. Usually involving threats to one’s survival, security, or self-esteem
(a) Once awakened, person becomes rapidly oriented and alert
(b) Dream experience causes significant distress or impairment in social, occupational, or other important functioning
(c) Cannot be due to another psychological disorder or substance use/abuse
(d) 10-50% children are afflicted
(i) Approx. 1% of adults

Front 23

Sleep Terror Disorder

Back 23

: Recurrent episodes of abrupt awakening from sleep, usually during the first third of the major sleep episode and beginning with a panicky scream
(a) Intense fear and signs of autonomic arousal such as tachycardia, rapid breathing, and sweating during each episode
(i) Relatively unresponsive to efforts of others to comfort the person during the attacks
(b) *No detailed dream can be recalled*
(c) Clinically significant distress and not due to another disorder
(d) Approx. 5% of children
(i) More males than females
(ii) <1% of adults

Front 24

Sleepwalking Disorder

Back 24

Somnambulism” occurs during nonREM sleep, so the person is not acting out a dream
(i) Typically occurs during the early hours of sleep
(b) Can be sitting up in bed, but generally is diagnosed with walking around during sleep
(i) Blank, staring face, relatively unresponsive to efforts to communicate with them
 Hard to awaken
(ii) May be disoriented or confused if awakened, but will become alert within a few minutes
(c) Approx. 15-30% of children have one episode
(i) 2% have multiple episodes
(ii) Few adults sleepwalk

Front 25

Circadian Rhythm Sleep Disorder

Back 25

1) Problems with sleep caused by the brain’s difficulty adjusting to current patterns of day and night
(a) Problems with the hypothalamus
(b) Amount of light is related to awakening increased alertness in the morning and slowing down and getting sleepy at night
(c) Several types: Jet Lag, Shift Work, Delayed Sleep Phase
(d) Impact on health can be extreme
(i) Increased rates of diseases such as cardiovascular disease, ulcers, and breast cancer
(ii) Greater risk of personality disorder

Front 26

Treatment for Sleep Disorders

Back 26

1) Prevention
(a) Short acting drugs that induce sleep
(i) Unless they induce anxiety
(b) Long acting drugs: more side effects and dependence is a risk
(i) Rebound insomnia
(ii) May be related to risk of injury or death through sleepwalking related problems
(c) Phase Delays: Going to bed later, gradual increase of time asleep
(d) Psychological: Stimulus control (use one’s bed only for sleep) and cognitive behavioral interventions