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40 Cards in this Set
- Front
- Back
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how is the Strange situation paradigm observation coded? (talk about attachment types, what it says about parent, high-low) |
Secure (consistent, responsive parenting), insecure avoidant (neglectful pareting), insecure/anxious/ambivalent/resistant( inconsistent parenting), disorganized/disoriented (frightening or abusive parenting)
high avoidance= avoidant, disorganizedhigh anxious= anxious, disorganizedLow anxious= secure, avoidant
Low avoidance= secure, anxious |
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Internal working model (3) |
- patterns of attachment organized my infants expectations of caregivers availability and responsiveness - model of self- expectations of their ability to manage distress and challenging situations- is developed through these interactions - Model of others- how others will respond in times of need- are also developed |
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How do the different attachment styles reflect the internal working model of others and self? |
Secure= caregiver available+ self: worthy of love + attention
Avoidant= caregiver unresponsive, self: not worthy Resistant= caregiver inconsistently available Self: confused Disorganized = caregiver: distorted availability, Self: incoherent model |
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How do the different attachment styles effect self regulation? |
- attachment system activated by perceived threat, danger, challenge (by novelty)this effects willingness to explore and this can affect learning
Secure will signal distress, Avoidant less so (not as obvous, ignore caregiver), Resistant also display distress, won’t explore, but stress is not reduced by the caregiver. Disorganized is a mix of avoidant and resistant
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Is attatchment stable? (3) what is the developmental outcome? (insecure vs secure; dis, avoidant, resistant, avoidant resistant) |
- attachment develop in first years of life and become stable over time - it is most sensitive to early environment but some change is expected over time. - Available and responsive care continues to be important Outcome: insecure- risk for psychopathology, internalizing or externalizing problems secure- positive /adaptive social and emotional development (protective) - disorganized- psychiatric symptoms, dissociation- avoidant - externalizing and conduct problems - resistant- anxiety problems predicted, beyond maternal anxiety - avoidant & resistant - depression |
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Minnesota study of Risk and Adaption form Birth to Adulthood |
- 30 year study, looked at 200 pregnant women below poverty line
- followed kids form birth to adulthood caregiving - early caregiving did influence attachment- mothers with secure attachments were more sensitive and cooperation compared to anxiously attached infants - those with resistant attachment, the mother had less psych awareness - disorganized attachment predicted intrusiveness and maltreatment of mothers |
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How do child characteristics effect attachment style? (3) |
- no direct effect of child temperament on attachment
- but caregiver sensitivity had stronger effect for less irritable infantsinfants wit resistant attachment else engagement and lagged developmentally - Mothers of girls with resistant attachment reported stressful life events |
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Secure attachments predicted development of higher: (3) compared to insecure |
- self reliance
- independence, less reliance on teachers - emotional regulation - self confidence, flexible coping - social competence - expectation of relationships, engagement with others, popularity, empathy |
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Describe the social characteristics of avoidant, secure, resistant, anxious avoidant, anxious resistant toddlers |
- avoidant, secure, resistant groups of toddles
- securely attached more social bore positively - avoidant = negative orientation- resistant- ignored mothers - anxious avoidant - hostile, impulsive, withdrawn, giving up easier, behavioural problems - Anxious resistant- similar to secure in compliance, but lacked agency, confidence, incompetent in peer interaction |
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stress-diathesis model of attachment |
- attachment associated with psychopathology in high -risk population= stress-diathesis model - low parental warmth predicts depression, even after controlling for maternal depression - attachment may have a much more subtle effect on psycho if not in stressful situations
Caregiving—> form internal working models—> caregiving and environment directly and indirectly influence development—> internal models used to interpret and respond to experiences —> models are adapted |
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the findings on relatiohsip between psychopathology and attachment are... |
inconsistent, finding multifinality, and divergent trajectories |
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look at this picture of the transdiagnostic model. What dos the model say about anxious and avoidant attachments? |
anxiety attachment—through up regulation of negative affectivity, hypervigience low perceived others responsiveness— can lead to anxiety disorder, MDD, PTSD, antisocialavoidant attachment - through low perceived others responsiveness, down-regulation of affectivity, compulsive self-reliance— can lead to PTSD, MDD, Antisocial |
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Biologically, securely attached parents have.... what are the results of this biologically in the parent and child? |
- more oxy baseline -this augments mesolimbic dopamine system, inhibits amygdala and augments Anterior insula= more response to infant cry+ its less negative more empathic. -This promotes Oxy activity in children= positive feedback loop |
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Intervention efficacy |
- intervened in homes where parent was reported for maltreatment
- record interactions, play back to parents - significant improvement in maternal sensitivity and child attachment (less disorganized) - reduction in behavioural problems |
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What are the Feeding and Eating disorders in the DSM? (8) |
- rumination disorder
- avoidant/restrictive food intake disorder - anorexia nervosa: restricting type, bing-eating/purging type - Bulimia nervosa - Binge-eating disorder - other specified feeding or eating disorder - unspecified feeding or eating disorder |
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What are the DSM criteria for Anorexia Nervosa? (3) subtypes? |
- restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health - intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though significantly low weight
- Disturbance in the way in which ones body weight or shape is experienced, undue influences of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Subtypes: restricting type (primarily through dieting, fasting + exercise), binge-eating type |
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What differentiates the binge-purge subtype of AN from BN? What differentiates BED from AN and BN? What differentiates BED from obesity? |
- smaller portions and more consistent purging than in bulimia; - BED more likely to be obese, age of onset is later, course of BED is different (dysfunctional dieting follows onset of BED, whereas dysfunctional dieting often precedes onset of BN) - CBT and IPT are associated with great improvements relative to weight loss programs in people with BED - BED individuals differ from those who are obese but of not have BED because of greater psychiatric co-morbidity, poorer functioning |
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Describe in detail the core features of Anorexia |
-->Persistent energy intake restriction
- severity in DSM 5 depends in BMI mile= >17, moderate= 16-16.99, severe= 15-15.99, extreme= <15- but BMI not only consideration. 18.5 BMI cutoff used by CDC and WHO but can depend on clinical history - treatment aim is usually 20 BMI for those with a history of eating disorders -->Intense fear of gaining weight - phobia of gaining weight - fear may not be alleviated by weight loss (may increase) - fear of gaining weight at times denied: focus on behaviour preventing weight gain -->Disturbance in self-perceived weight or shape- distortions in self-view (not always present) - excessive focus on body weight and shape - weight and shape tied to self esteem + concept- thinness valued over health - can also overvalue the control of weight itself - seen as discipline |
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What are some clinical correlated of AN? (4) |
- rigid, inflexible thinking
- don’t like alternatives, or change - depressive symptoms - perfectionism - Obsessive compulsive features both related to and unrelated to food - strong need to control ones environment |
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What is the DSM criteria for Bulimia Nervosa? (4) |
- recurrent episodes of binge eatinga) eating in a discrete period of time (like 2hrs) an amount of food that is definitely larger that what most individuals would eatb) sense of lack of control over eating
- recurrent inappropriate compensatory behaviours in order to prevent weight gain like vomitng, laxatives, fasting, excessive exercise - binge eating and inappropriate compensatory behaviours occur at least once a week for 3 months - self evaluation unduly influenced by body shape + weight
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Changes from DSM 4-5 for Anorexia + Bulimia |
- many eating disorder patients were diagnosed as EDNOS - no amenorrhea, AN symptoms but healthy weight, frequency of bing/purge, other symptoms- to address this problem, changes were applied to the DSM 5 criteria:anorexia removed requirement for amenorrheabulimia: reduces frequency from 2x week to 1x week creation go bing eating disorder - purging + non purging subtypes were removed in the DSM5 |
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Describe the core features of BN (4) |
- Bing eating: roughly 1500 calories in a binge, shame
- compensatory behaviours: severity based in frequency in a week: mild= 1-3, moderate 4-7, severe 8-13, extreme= 14+ - in clinical samples, vomiting most common behaviour, in community samples, exercise and strict diet most common - self evaluation: dominated by shape and weight, unlike AN typically in normal range |
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What are some clinical correlates of BN? |
- impulsivity
- substance abuse - self-injury and BPD- childhood abuse? mixed evidence - perfectionism+ depressive symptoms |
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What is the DSM criteria for binge eating disorders? |
- recurrent episodes of binge eating a) eating in a discrete period of time (like 2hrs) an amount of food that is definitely larger that what most individuals would eatb) sense of lack of control over eating
- episodes are associated with 3 or more of: a) eating more rapidly than normal b) eating until uncomfortable c) eating large amounts when not physically hungry d) eating alone bc of feeling embarrassed e) feeling disgusted with oneself, depressed, or very guilty - marked distress regarding binge eating is present - binge eating occurs on average at least once a week for 3 months - binge eating not associated with the recurrent use of inappropriate compensatory behaviour |
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What is the prevalence of AN, BED, BN? Gender differences? |
- 1%, more females than males, thinness vs athleticism in males, influence of sexual orientation- homosexual men may be more likely
Bulimia: - 2%, more females than males BED: 1-2.5%, gender dif less skewed but more females than males |
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What us the etiology of Eating disorders ? |
biological factors: based on family studies with ED, AN heritability is 58-78%, BN 30-83% Family environment: parents attitudes toward eating and weight, encouragement Social influences: peer influences, social contagion, preadolescent obesity linked to ED (teasing) Cultural influences:media (AN most prevalent in western industrialized cultures, Bulimia even more affected by culture), societal pressures |
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Describe the Fiji TV study |
1990s in Fiji there was 1 reported case of anorexia. Then 1995 tv came and after one month, 8 out of 63 girls had disordered eating. 3 years later, 19 of 65 girls had disordered eating and 7 vomited to control weight 77% reported that TV has influenced body image |
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Describe the course of ED |
- usually appear during adolescence
- diathesis-stress model - dieting often trigger - fluctuating course, with high rates of relapse. AN less than 50% recover, BN 50-75% but body dissatisfaction may remain high, BED more likely to improve than AN or BN |
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What are some physical consequences of anorexia and bulimia? |
Anorexia- physical symptoms: dry mouth, skin, sensitivity to cold, gusto-intestinal symptoms, cardio problems
- high death rate: mortality of 5-10% highest of all clinical diagnosis’s,. Death commonly for cardio problems from electrolyte imbalances. Bradycardia is common cause of death Bulimia - puffy cheeks, fatigue, loss of dental enamel, tears in stomach, electrolyte imbalance+ cardio consequences |
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Why are eating disorders so hard to treat? |
they are ego-syntonic= in line with desires or goals of ego, denial there is a problem, patients like some aspects of their disorder |
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Is CBT effective for ED? what are common approaches? |
Effectiveness- CBT found to be effective in treating bulimia -limited evidence for effective treatment due to ethical problems and rare incidence outcome evidence: 50% of BN patients cease binging ad purging following 16-20 weeks of CBTBest prognosis - large initial reductions in binge+ purge Worst - Borderline PD, substance abuse
- common approaches: individual treatment, family therapy |
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What do phase 1 and 2 of CBT for Bulimia entail? |
PHASE 1: behavioural - explain treatment - set goals - formulate problems & psychoeducation - start weekly self-monitoring - develop regular eating habits (3 meals per day) - replace bingeing with pleasurable activities
PHASE 2: cognitions - identify maladaptive cognitions - cog reconstructing - thought records, examine evidence for distorted thoughts - identify maintaining mechanisms - target fear of weight hain - problem-solving |
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How does Family therapy see anorexia? What are the phases? |
- as a family problem, as a developmental setback, parents must step in Phase 1: parental refeeding - teen identified as unable to care for herself - parents are coached to work as a team to develop and maintain a plan to feed child - eat all meals as a family - high calorie diet Phase 2: cognitive distortions and family structure - target patients disorted body image and beliefs about food - problematic family patterns - role of eating in family life Phase 3: Adolescent issues - return responsibility for eating to the adolescent - foster adolescent autonomy - teach problem -solving skills
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Is family therapy for AN effective? who is generally prescribed this? |
Outcome evidence- data is promising 39-68 moderate or good outcome
candidates for family therapy: under 18 years old, live with parents, inappropriate for adult AN |
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what are some common challenges in treatment? |
- motivation - resistance to journaling + weighing - medical complications - plateau of gains - change in diagnosis but continued symptoms - relapse |
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what is the overweight and obesity cutoff? |
overweight= 85-95 percentile BMI obesity is 95 over hispanic boys and black girls more likely to be obese |
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Avoidant/restrictive food intake disorder, what is FTT |
- avoidance/ restriction of food, can begin at any age, but listed as a childhood one -leads to sig weight loss and nutritional deficiency - if onset is during first 2 years can lead to developmental consequences - Failure to Thrive FTT= term used to describe growth problems caused by this - linked to poor caregiver care- mothers of these kids found to be more insecurely attached |
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What is Pica? why does it affect and why? |
- ingestion of inedible substances - still eat normal foods - primarily affects very young children, higher prevalence in those with ID - may develop bc of poor environment conditions/ lack of stimulation/supervision
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Men vs women & eating disorders |
- clinically present the same but men have preoccupation with being muscular - men more likely to engage in excessive exercise and overeating, women to report loss of control - sexual abuse in women makes them much more likely to have bulimia |
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What neurotransmitter is implicated in ED? |
- serotonin controls fullness - link btwn OCD and ED to do with serotonin |
