1
Q
unipolar depressive disorders
A
major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, disruptive mood dysregulation disorder
2
Q
bipolar disorders
A
bipolar I disorder, bipolar II disorder, cyclothymia
3
Q
DSM-5 criteria for major depressive disorder
A
- sad mood OR loss of interest and pleasure (i.e., anhedonia)
- at least 5 symptoms in total, including other symptoms such as: sleeping too much or too little; psychomotor retardation or agitation; poor appetite and weight loss or increased appetite and weight gain; loss of energy; feelings of worthlessness or excessive guilt; difficulty concentration, thinking, or making decisions; recurrent thoughts of death or suicide
4
Q
major depressive disorder (MDD)
A
episodic; recurrent; patients may present with quite varied symptom presentations; useful to consider depression symptoms as a continuum of severity
5
Q
over ____ different symptom combinations are possible for MDD
A
1,000
6
Q
age of onset for MDD
A
symptoms are present: nearly every day, most of the day, for at least 2 weeks
7
Q
DSM-5 criteria for persistent depressive disorder (PDD)
A
- depressed mood for at least 2 years (1 year for children/adolescents)
- plus 2 other symptoms: poor appetite or overeating; sleeping too much or too little; low energy; poor self-esteem; trouble concentrating or making decisions; feelings of hopelessness
- not as severe of a form of depression as MDD
- symptoms do not clear for more than 2 months at a time
- no symptoms of mania
8
Q
age of onset for PDD
A
- depressed mood for at least 2 years
- depressed mood for at least 1 year for children/adolescents
9
Q
epidemiology of depression
A
- 16.2% lifetime prevalence of MDD
- 5% of people with depression experience it for more than 2 years
- twice as common in women as in men
- three times as common among people in poverty
- prevalence and symptoms vary across cultures
10
Q
age of onset of depression
A
early 20s; average age of onset has decreased over past 50 years
11
Q
comorbidity of depression
A
- 5-30% with MDD also experience PDD
- 60% of those with MDD will also meet criteria for anxiety disorder at some point
12
Q
defining feature of each type of bipolar disorder
A
severity and duration of mania
13
Q
mania
A
state of intense elation, irritability, or activation
14
Q
hypomania
A
symptoms of mania but less intense; does not involve significant impairment
15
Q
depressive episode required for bipolar __ but not bipolar __
A
II; I
16
Q
DSM-5 criteria for manic and hypomanic episodes
A
- distinctly elevated or irritable mood
- abnormally increased activity and energy
- plus three other symptoms (4 if mood is irritable): increased goal-directed activity or psychomotor agitation; talkativeness, rapid speech; flight of ideas or racing thoughts; decreased need for sleep; increased self-esteem or grandiosity; distractibility, attention easily diverted; excessive involvement in activities that are likely to have undesirable consequences (e.g., reckless spending/sexual behavior/driving)
- symptoms are present most of the day, nearly every day
17
Q
DSM-5 criteria for a manic episode
A
- symptoms last at least 1 week, require hospitalization, or include psychosis
- symptoms cause significant distress or functional impairment
18
Q
DSM-5 criteria for a hypomanic episode
A
- symptoms last at least 4 days
- clear changes in functioning that are observable to others, but impairment is not marked
- no psychotic symptoms are present
19
Q
DSM-5 criteria for cyclothymia
A
- milder, chronic form of bipolar disorder
- symptoms last at least 2 years in adults; 1 year in children/adolescents
- numerous periods with hypomanic and depressive symptoms but does not meet criteria for hypomania or major depressive episode
- symptoms do not clear for more than 2 months at a time
20
Q
age of onset of cyclothymia
A
- symptoms last at least 2 years in adults and 1 year in children/adolescents
- periods with hypomanic or major depressive episode symptoms do not clear for more than 2 months at a time
21
Q
epidemiology of bipolar disorders
A
- prevalence rate lower than MDD
- 1% in US, 0.6% worldwide for bipolar I
0.4%-2% for bipolar II
4% for cyclothymia - average age of onset in 20s
- no gender differences in rates
22
Q
etiology of mood disorders - genetic influences
A
- heritability estimates (% of disorder caused by genetic factors): 37% MDD, 80% bipolar disorder
- unlikely one gene explains these illnesses; more likely gene x environment interaction
- serotonin transporter gene (5-HHT) polymorphism
23
Q
etiology of mood disorders - neurotransmitters
A
- norepinephrine, dopamine, serotonin, GABA
- some findings suggest neurotransmitters may relate more to specific symptoms rather to MDD diagnostic status
- new models focus on sensitivity of postsynaptic receptors
24
Q
etiology of mood disorders - neural regions involved in emotion and reward processing
A
- oversensitivity to emotional stimuli –> elevated amygdala
- interference with emotion regulation –> elevated anterior cingulate, diminished prefrontal cortex and hippocampus
- motivation to pursue rewards (striatum)
- disruptions in the connectivity of these regions
25
etiology of mood disorders - neuroendocrine system (cortisol dysregulation)
overreactivity of HPA axis --> amygdala activates HPA axis, which releases cortisol; cortisol increases activity of immune system to prepare for threat; prolonged high cortisol levels can cause harm to body systems
26
etiology of mood disorders - immune system (cytokines)
prolonged responses of cytokines can become problematic
27
cytokines
proteins released as part of an immune response to help fight infection
28
two pro-inflammatory cytokines linked to depression-like symptoms
IL-1 beta and TNF alpha
29
etiology of mood disorders - social influences
- 42-67% report a stressful life event in year prior to depression
- 40% risk of developing depression when experiencing stressful life event without support (4% with support)
- childhood abuse increases other biological and cognitive risk factors for depression and is associated with increased life stressors
- high levels of expressed emotion predict relapse
- marital conflict also predicts depression
30
etiology of mood disorders - psychological factors in depression
- neuroticism
- cognitive theories --> negative thoughts and beliefs cause depression; Beck's theory, hopelessness theory, rumination theory
31
neuroticism
tendency to experience frequent and intense negative affect
32
Beck's theory
- negative triad: negative view of self, world future
- negative schema --> underlying tendency to see the world negatively
- cognitive biases --> tendency to process information in negative ways due to negative schema
33
hopelessness theory
- most important trigger of depression is hopelessness
- attributional style --> negative life events are due to causes that are stable and global
34
attributional style: stable
they'll always be around (ex. I failed this exam because I can never do well on exams)
35
attributional style: global
they affect everything I do (ex. I was not only incompetent with this exam, but I am incompetent with everything. I will never be able to get a good job.)
36
rumination theory
- a specific way of thinking: tendency to repetitively dwell on sad thoughts
- thinking about a recent situation, wishing it had gone better; natural attempt at problem solving, but it doe not help so they get stuck thinking about it
- rumination confers risk for the first onset of depression
37
integrating biological and social influences on depression
- several links between social stressors and biological risk factors in depression
- bi-directional relationships: stress impacts biology and biology can also impact response to stress
38
social and psychological factors in bipolar disorder
- triggers of depressive episodes in bipolar disorder appear similar to triggers in MDD
- negative life events, neuroticism, negative cognitions, negative expressed emotion, and lack of social support
- predictors of mania --> reward sensitivity (high responsiveness to rewards)
- sleep disruption
39
interpersonal psychotherapy (IPT)
- psychological treatment of depression
- focus on major interpersonal problems
- identify feelings, make decisions, and resolve problems related to interpersonal issues
40
cognitive therapy (CT) - depression
- psychological treatment of depression
- altering maladaptive thought patterns
- monitor and identify automatic thoughts
41
mindfulness-based cognitive therapy (MBCT)
- use of strategies, including meditation, to detach from depression-related thoughts and prevent relapse
- change relationship with thoughts
- increasing awareness of thoughts and emotions
- not trying to change or avoid thoughts and emotions, instead learn to tolerate them
- compassion, non-judgmentalness
42
behavioral activation (BA) therapy
- psychological treatment of depression
- increase participation in positively reinforcing activities to disrupt spiral of depression, withdrawal, and avoidance
43
behavioral couples therapy
- psychological treatment of depression
- enhance communication and relationship satisfaction
44
psychological treatments of depression
- interpersonal psychotherapy (IPT)
- cognitive therapy (CT)
- behavioral activation (BA) therapy
- behavioral couples therapy
45
psychological treatments of bipolar disorder
psychoeducational approaches, cognitive therapy, family-focused treatment (FFT)
46
psychoeducational approaches
- psychological treatment of bipolar disorder
- provide information about symptoms, course, triggers, and treatments
47
cognitive therapy (CT) - bipolar disorder
- psychological treatment of bipolar disorder
- similar to depression treatment with additional content to address early signs of mania
48
family-focused treatment (FFT)
- psychological treatment of bipolar disorder
- educate family about disorder, enhance family communication, improve problem solving
49
biological treatment of mood disorders
medications, electroconvulsive therapy (ECT), transcranial magnetic stimulation depression (rTMS)
50
medications for treating mood disorders
antidepressants, mood stabilizers
51
antidepressants
MAO inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI)
52
mood stabilizers
lithium, anticonvulsants, antipsychotics
53
medications for bipolar disorder
- lithium
- mood stabilizers: anticonvulsants, antipsychotics
54
electroconvulsive therapy (ECT)
- reserved for treatment non-responders
- induce brain seizure and momentary unconsciousness
- side effects: short-term confusion and memory loss
55
transcranial magnetic stimulation for depression (rTMS)
- electromagnetic coil placed against scalp
- pulses of magnetic energy increase activity in the brain
- for those who fail to respond to first antidepressant
56
two types of suicidal ideation (SI)
passive SI and active SI
57
passive SI
wishing one were dead; ex. "If I were hit by a car right now, I'd be okay with that"
58
active SI
thoughts about killing oneself
59
suicide attempt (SA)
behavior with the intention of ending one's life
60
interrupted suicide attempt
person starts to take steps to end their life but someone or something stops them
61
aborted suicide attempt
person starts to take steps to end their life but stops themselves
62
non-suicidal self-injury
self-harm without suicidal intent
63
common reasons for self-harm
- reduce negative affect (negative reinforcement)
- increase positive affect (positive reinforcement)
- feel something when feeling numb or empty
- social reinforcement (get reaction/support from others)
64
epidemiology of suicide risk
- suicide rates in US continue to increase, specifically in adolescents
- attempts at suicide are more prevalent in females, but completed suicide is more prevalent in males
- 12.2 million adults had serious thoughts of suicide
- 3.2 million adults made suicide plans
- 1.2 million adults attempted suicide
65
suicide and Covid-19
- suicide deaths initially appeared to decrease during Covid-19
- stay at home orders may have increased many other potential risk factors for suicide
- younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation
66
epidemiology of suicide and suicide attempts
- 10th leading cause of death in US
- 9% report suicidal ideation at least once in their lives and 2.5% have made at least one suicide attempt worldwide
- guns are most common means of suicide in the US
- highest rates of suicide in US are for American Indian and white males over age 50
- being divorced or widowed elevates suicide risk four- or fivefold
67
risk factors for suicide
- psychological disorders
- heritability of about 50% for suicide attempts
- low levels of dopamine
- abnormal cortisol regulation
- economic recessions
- media reports of suicide
- history of multiple physical and sexual assaults
- perceived sense of burden to others and a lack of social belonging
68
suicide risk across developmental-social ecological model
- individual level
- relationship level
- community level
- societal level
69
individual level - developmental-social ecological model
- history of depression and other mental illness
- hopelessness
- substance abuse
- certain health conditions
- previous suicide attempt
- violence victimization and perpetration
- genetic and biological determinants
70
relationship level - developmental-social ecological model
- high conflict or violent relationships
- sense of isolation and lack of social support
- family/loved one's history of suicide
- financial and work stress
71
community level - developmental-social ecological model
- inadequate community connectedness
- barriers to health care
72
societal level - developmental-social ecological model
- availability of lethal means to suicide
- unsafe media portrayals of suicide
- stigma associated with help-seeking and mental illness
73
risk factors for suicide - psychological models
ineffective problem-solving, hopelessness, impulsivity, ideation vs. action
74
3-step theory of suicide
1) Are you in pain and hopelessness --> yes: suicidal ideation; no: no ideation
2) Does your pain exceed your connectedness --> yes: strong ideation; no: modest ideation
3) Do you have the capacity to attempt suicide? --> yes: suicide attempt; no: ideation only
75
suicide risk in children and adolescents
- ages 12-19
- LGBTQ+ sexual orientation
- personal history of: suicide attempt(s), any NSSI, abuse (physical and/or sexual), witness to violence, suicidal behavior, or suicide
- family history of: psychiatric illness, suicide
- current psychiatric disorder
- psychological symptoms: insomnia, burdensomeness, impulsivity, active suicidal ideation
- access to lethal means: firearms, means for suffocation
- interpersonal conflicts
- bullying (victim, perpetrator, or both)
- legal trouble/incarceration
- current substance abuse
- social isolation
76
suicide risk in midlife
- current psychiatric disorder
- Psychiatric symptoms: agitation, insomnia, hopelessness, impulsivity
-marriage status
- active military
- psychiatric hospitalization course
- recent arrests or incarceration
- recent loss of job/financial distress
- current conflicts within romantic relationship
- access to lethal means
77
suicide risk in older adulthood
- physical and cognitive limitations
- goals no longer attainable using previous strategies
- compensatory strategies not employed; high value placed on autonomy and inflexible cognitive style
- unable to attain important goals
- hopelessness, suicidal ideation
78
preventing suicide
- talk about suicide openly and matter-of-factly
- treat the associated mental health disorder
- treat suicidality directly
- hospitalization for safety
79
broader approaches to suicide prevention
- studying suicide prevention within the military
- means restriction (make highly lethal methods less available)
80
clinical description of schizophrenia
- influences the way a person thinks, feels, and behaves
- disordered thinking
- faulty perception and attention
- lack of emotional expressiveness
- disturbances in movement or behavior
- widespread disruptions in life
- rates of substance use, suicide, and mortality are high
- considered a severe mental illness
- lifetime prevalence ~1%
- affects men slightly more often than women
- diagnosed more frequently in Black and Latinx Americans
- often experience several acute episodes with less severe symptoms between episodes
81
age of onset for schizophrenia
- typically in late adolescence/early adulthood
- men diagnosed at a slightly earlier age
82
positive symptoms of schizophrenia
- excesses and distortions
- includes delusions and hallucinations
- characterize acute episodes of schizophrenia
83
delusions
beliefs contrary to reality; firmly held despite disconfirming evidence
84
types of delusions
thought insertion, delusions of control, thought broadcasting, delusions of reference, grandiose delusions, persecutory delusions
85
thought insertion
delusion that someone else put thoughts into one's head
86
delusions of control
delusion of being controlled by another person
87
thought broadcasting
delusion that other people can hear one's thoughts
88
delusions of reference
delusion of making personally-relevant connections between unrelated things or coincidences
89
grandiose delusions
delusion of unfounded beliefs that one has special powers, wealth, mission, or identity
90
persecutory delusions
believe someone or something is mistreating, spying on, or attempting to harm them (or someone close to them)
91
hallucinations
sensory experiences in the absence of sensory stimulation; most often auditory and visual
92
people who have auditory hallucinations may misattribute...
their own voice as someone else's voice
93
two domains of negative symptoms of schizophrenia
1) motivation and pleasure domain
2) expression domain
94
motivation and pleasure domain of negative symptoms of schizophrenia
avolition, asociality, anhedonia
95
avolition
diminished motivation; apathy
96
asociality
little interest in being around others and having close relationships
97
anhedonia
inability to experience pleasure
98
expressive domain of negative symptoms of schizophrenia
blunted affect, alogia
99
blunted affect
lack of outward expression of emotion, inner emotional experience is often not affected
100
alogia
significant reduction in amount of speech
101
disorganized symptoms of schizophrenia
disorganized speech, disorganized behavior
102
disorganized speech (formal thought disorder)
problems in organizing ideas and in speaking coherently; difficulty sticking to one topic
103
disorganized behavior
difficulty organizing behaviors and conforming to community standards; catatonia
104
catatonic
peculiar, increased, repeated gestures or immobility
105
DSM-5 criteria of schizophrenia
- two or more of the following symptoms for at least 1 month; one symptoms should be either 1, 2, or 3:
1) delusions
2) hallucinations
3) disorganized speech
4) disorganized behavior
5) negative symptoms
- functioning in work, relationships, or self-care has declined since onset
- signs of disorder for at least 6 months
- during a prodromal or residual phase, negative symptoms or two or more symptoms 1-4 in less severe form
106
schizophreniform disorder
- same symptoms as schizophrenia
- symptom duration greater than 1 month but less than 6 months
- symptoms often brought on by extreme stress, such as bereavment
107
brief psychotic disorder
- same symptoms but shorter duration
- may be brought on by extreme stress
- symptoms last 1 day to 1 month
108
schizoaffective disorder
- symptoms of both schizophrenia and mood disorders
- must have either a depressive and/or manic episodes
- psychotic symptoms must be independent of mood episodes
109
delusional disorder
- persistent delusions lasting at least 1 month
- no other psychotic symptoms
110
etiology of schizophrenia - genetic influences
- research supports genetic component (family studies, twin studies, adoption studies, GWAS studies)
- heritability estimate .77
- genetically heterogenous
111
behavioral genetics research
- relatives at increased risk
- risk increases as genetic relationship becomes closer
- negative symptoms have stronger genetic component
- incidence highest among children with both parents with a schizophrenia or bipolar disorder diagnosis
- the role of environment cannot be discounted
112
dopamine theory of schizophrenia
- theory that schizophrenia is due to excess levels of dopamine
- revised: excess dopamine receptors related mainly to positive and disorganization symptoms; evidence linking dopamine to specific negative symptoms of avolition and anhedonia
113
other neurotransmitters that may affect shizophrenia
serotonin; glutamate
114
brain structure and function - enlarged ventricles
- implies loss of brain cells
- correlated with: poor performance on neuropsychological tests, poor functioning prior to onset of disorder, poor response to medication treatment
115
brain structure and function - factors involving prefrontal cortex
- plays a role in speech, decision making, emotion, goal-directed behavior
- reduction in gray matter and overall volume
- less activation of prefrontal cortex during cognitive tasks is associated with more severe negative symptoms
116
brain structure and function - temporal cortex and subcortical brain regions
- structural and functional abnormalities in the temporal cortex and other subcortical brain regions (temporal gyrus, hippocampus, parts of the insula, fusiform gyrus, cingulate, amygdala, thalamus, and basal ganglia)
- reduced hippocampal volume
117
brain structure and function - connectivity in the brain
- less connectivity in brain white matter in frontal and temporal cortices
- less connectivity between brain networks
118
brain structure and function - early environmental factors
- damage during gestation or birth --> high rates of delivery complications
- maternal infection
119
brain structure and function - brain development factors
- prefrontal cortex matures in adolescence or early adulthood
- dopamine activity also peaks in adolescence
- adolescence is a time fraught with stress
- excessive pruning of synaptic connections
- use of cannabis during adolescence associated with increased risk
- stress may explain why symptoms appear in late adolescence even though brain abnormalities occur early in life
120
psychological factors of schizophrenia - stress
greater vulnerability to stress
121
psychological factors of schizophrenia - sociocultural
- poverty
- trauma
- urbanicity
- migration
122
psychological factors of schizophrenia - family factors
- schizophrenogenic mother
- family relationships do not cause schizophrenia, but may influence course of the illness
123
psychological factors of schizophrenia - families and relapse
- expressed emotion (EE): hostiity, critical comments, emotional overinvolvement; cultural differences
- bidirectional association
124
bidirectional association
- expression of unusual thoughts by person with schizophrenia --> increase critical comments by family
- critical comments by family --> increase unusual thoughts by person with schizophrenia
125
retrospective developmental studies
- developmental histories: lower IQ; more often delinquent, withdrawn, disagreeable (boys), passive (girls)
- coding of home movies: poorer motor skills, more expression of negative emotion
126
first-generation antipsychotics for schizophrenia
- reduce positive and disorganization symptoms, little or no effect on the negative symptoms
- many stop due to side effects
- maintenance dosages help to prevent relapse
127
second-generation antipsychotics for schizphrenia
- equally as effective as first-generation at reducing positive symptoms and disorganization; modestly more effective at reducing negative symptoms; more effective at improving cognitive functioning
- also produce unpleasant side effects: weight gain
128
psychological treatments of schizophrenia
- Patient Outcomes Research Team (PORT) treatment recommendation
- combined treatment (associated with lower rates of relapse and treatment discontinuation as well as greater improvements in functioning)
129
Patient Outcomes Research Team (PORT) treatment recommendation
- medication plus psychosocial intervention
- social skills training, cognitive behavior therapy, and family-based treatments
130
psychological treatments of schizophrenia - social skills training
- teach skills for managing interpersonal situations
- involves role-playing and other practice exercises, both in group and in vivo
- associated with fewer relapses, better social functioning, and a higher quality of life
131
psychological treatments of schizophrenia - family therapies
- goal: reduced expressed emotion
- components common across family therapies for schizophrenia: education about schizophrenia, information about antipsychotic medications, blame avoidance and reduction, communication and problem-solving skills within family, social network expansion, instilling hope
132
psychological treatments for schizophrenia - psychoeducation
- educate people about their illness
- effective in reducing relapse and rehospitalization and increasing medication compliance
133
cognitive behavioral therapy for schizophrenia
- recognize and challenge delusional beliefs
- reduces negative symptoms: challenging belief structures tied to low expectations for success and pleasure
- earlier the treatment begins, the better the outcome
134
cognitive behavioral therapy combined treatments for schizophrenia
- cognitive-behavioral social skills training (CBSST)
- NAVIGATE treatment program
135
cognitive-behavioral social skills training (CBSST)
- treats schizophreia
- combines social skills training and cognitive behavioral therapy
- focuses on reducing symptoms and improving functioning
136
NAVIGATE treatment program
- shown promise for young people early in schizophrenia course
- combines medication, family psychoeducation, individual therapy, and assistance with employment and education
- better outcomes with earlier intervention
137
psychological treatments for schizophrenia - residential treatment
- helpful for people not able to live on their own or with family
- vocational rehabilitation
-residents learn marketable skills thereby increasing community functioning
- need follow-up community services following discharge, but these services can be scarce
138
dissociation
some aspect of emotion, memory, or experience being inaccessible consciously
139
causes of dissociation
- psychodynamic and behavioral theorist --> an avoidance response that protects the person from consciously experiencing stressful events
- trauma and sleep disturbance
140
depersonalization/derealization disorder
- disconcerting and disruptive sense of detachment from one's self and surroundings
- symptoms are persistent or recurrent
- does not involve disturbance of memory
- symptoms are usually triggered by stress
- may be related to difficulties integrating sensory and somatic information
- childhood trauma is often reported
- usually begins in adolescence
- symptoms should not be entirely explained by other disorders
141
depersonalization
a sense of detachment from one's self; experiences of detachment from one's mental processes or body, as though one is in a dream
142
derealization
a sense of detachment from one's surroundings; experiences of unreality of surroundings
143
DSM-5 criteria of depersonaization/derealization disorder
- depersonalization or derealization
- symptoms are persistent or recurrent
- reality testing remains intact
- symptoms are not explained by substances, another dissociative disorder, another psychological disorder, or by a medical condition
144
dissociative amnesia
inability to recall important personal information, usually about a traumatic experience
- typically occurs after severe stress
- may last several hours to several years
- usually disappears as suddenly as it began, with complete recovery of memory
- procedural memory remains intact
145
causes of dissociative amnesia
- psychodynamic theory --> traumatic events are repressed
- cognitive theory
- little known about etiology
146
dissociative amnesia - dissociative fugue subtype
- most severe subtype, extensive memory loss
- person typically disappears from home and work; may assume a new identity
- recovery is usually complete; people are able to remember details of their life except for those events that took place during the fugue
147
DSM-5 criteria of dissociative amnesia
- inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness
- amnesia not explained by substances or by other medical or psychological conditions
- dissociative fugue subtype if amnesia is associated with bewildered or apparently purposeful wandering
148
dissociative identity disorder (DID)
a person has at least 2 separate personality state (alters)
- each has different modes of being, thinking, feeling, and acting
- alters exist independently of one another
- alters emerge at different times
- primary alter may be unaware of existence of other alters
- primary alter may have no memory of what other alters do
- the individual may not necessarily perceive these as separate personalities, but rather as dramatic shifts in their sense of self and agency and recurrent periods of amnesia
- usually the primary alter seeks treatment
- most commonly, 2-4 alters are identified when diagnosed
- rarely diagnosed until adulthood
- more common in women than men
- other common symptoms: headaches, hallucinations, suicide attempts, self-injurous behaviors, amnesia, depersonalization
149
DSM-5 criteria - DID
- disruption of identity characterized by two or more distinct personality states (alters) or an experience of possession
- disruptions lead to discontinuities in the sense of self or agency
- reflected in altered cognition, behavior, affect, perceptions, consciousness, memories, or sensory-motor functioning
- recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting
- symptoms are not part of a broadly accepted cultural or religious practice
150
epidemiology of dissociative disorders
- 2.5% lifetime prevalence of depersonalization/derealization
- 7.5% lifetime prevalence of dissociative amnesia
- 1-3% lifetime prevalence of dissociative identity disorder
- increased rates since 1970s
151
posttraumatic model of dissociative disorders
- children who are abused are at risk for developing dissociative symptoms
- children who dissociate are more likely to develop psychological symptoms are trauma
152
sociocognitive model of dissociative disorders
- people who have been abused seek explanations for their symptoms and distress
- alters appear in response to suggestions by: therapists, exposure to media reports of DID, other cultural influences
- DID could be iatrogenic (created within treatment)
153
evidence in support of the sociocognitive model of DID
- the symptoms of DID can be faked
- some therapists reinforce DID symptoms: use of hypnosis, urging clients to unbury unremembered abuse experiences, naming different alters; most clients are unaware of having alters before treatment; rapid increase in number of alters as treatment progresses
- alters share memories, even when they report amnesia
154
availability of treatments for DID
- no well-validated treatments available
- medications not shown to relieve symptoms
155
psychodynamic treatment of DID
- goal: overcome repression
- use of hypnosis --> age repression; can actually worsen symptoms
156
somatic symptoms and related disorders of DID
- excessive concerns about physical symptoms or health
- distress over symptoms is authentic
- tendency to seek frequent medical treatment
157
DSM-5 criteria of somatic symptom disorder
- at least one somatic symptom that is distressing or disrupts daily life
- duration of at least 6 months
- specify if predominant pain
- excessive thoughts, distress, and behaviors related to somatic symptom(s) or health concerns, as indicated by at least one of the following: health-related anxiety, disproportionate and persistent concerns about the seriousness of symptoms, excessive time and energy devoted to health concerns
158
somatic symptom disorder
- distress revolves around a somatic symptom that exists
- can be diagnosed regardless of whether symptoms can be explained medically
159
illness anxiety disorder
- preoccupation with fears of having a serious disease despite having no significant somatic symptoms
- easily alarmed about their health
- may be haunted by visual images of becoming ill or dying
- may react with anxiety when they hear about illnesses in their friends or in the community
- fears are not easily calmed
160
DSM-5 criteria of illness anxiety disorder
- preoccupation with and high level of anxiety about having or acquiring a serious disease
- excessive behaviors or maladaptive avoidance
- no more than mild somatic symptoms are present
- preoccupation lasts at least 6 months
161
DSM-5 criteria of conversion disorder
- one or more symptoms affecting voluntary motor or sensory function
- the symptoms are incompatible with recognized medical disorders
- symptoms cause significant distress or functional impairment or warrant medical evaluation
162
conversion disorder
sudden development of neurological symptoms:
- partial or complete paralysis of arms or legs
- seizures or coordination problems
- vision impairment or tunnel vision
- anesthesia --> insensitivity to pain
- aphonia --> whispered speech
- the symptoms suggest an illness related to neurological damage
- many people show no signs that they are amplifying their symptoms
- onset typically adolescence or early adulthood
- prevalence less than 1%
163
etiology of somatic symptom-related disorders
- do not appear to be heritable
- little is known about the etiology
164
neurobiological factors of somatic symptom-related disorders
- anterior insula and anterior cingulate cortex
- somatosensory cortex
- heightened activity in these regions is related to greater propensity for somatic symptoms
- pain and somatic symptoms can be increased by anxiety, depression, and stress hormones
165
two variables to cognitive behavioral factors of somatic symptom-related disorders
1) attention to bodily sensations --> automatic focus on physical health cues
2) interpretation of those sensations --> overreact with overly negative interpretations
166
cognitive behavioral factors of somatic symptom-related disorders - behavioral consequences
- assuming the sick role, which intensifies poor health
- safety behaviors: prevents extinction of fear, maintains focus on potential health concerns
167
etiology of conversion disorder - psychodynamic perspective
physical symptom is a response to an unconscious psychological conflict
168
etiology of conversion disorder - neuroscience perspective
much of our perceptual processing may operate outside of our conscious awareness
169
etiology of conversion disorder - social and cultural factors
- more common among people from rural areas and of lower socioeconomic status
- social factors shape how conversion symptoms unfold
170
major obstacles of somatic symptom-related disorders
- most people want medical care
- referral to mental health may be viewed as invalidating
- a reminder of the mind-body connection can enhance their willingness to consider psychological treatment
171
cognitive behavioral strategies for somatic symptom-related disorders
- identify and change triggering emotions
- change cognitions about symptoms
- change behaviors to improve social interactions
- train people to pay less attention their body
- help people resume healthy activities and rebuild life
- involve family members to reduce attention (reinforcement) given to somatic symptoms
- mindfulness can help patients disengage from a focus on their symptoms
- internet-based approaches may also be helpful with brief clinician guidance
172
treatment of conversion disorder
CBT for specific forms of conversion disorder
173
substance use disorders and gender
more common in men than women, but the gap is narrowing
174
two key symptoms of substance use disorder
1) tolerance --> larger doses of drug needed to produce desired effect
2) withdrawal --> negative physical and psychological effects from stopping substance use
175
DSM-5 criteria for SUDs
- problematic pattern of use that impairs functioning
- two or more symptoms within a 1-year period: failure to meet obligations; continuing to use even in situations where it is physically dangerous; repeated relationship problems; continuing to use despite problems caused by the substance; tolerance; withdrawal; substance is taken for longer time or greater amounts than intended; efforts to reduce or control substance use do not work; much time is spent trying to get the substance; social events, hobbies, and /or work are given up or reduced; strong craving to use the substance
176
alcohol use disorder (AUD)
- dependence (addicted)
- alcohol withdrawal
- associated with other drug use
177
dependence
people who develop tolerance or withdrawal
178
alcohol withdrawal
- muscle tremors, elevated pulse, blood pressure, and temperature
- delirium tremors
179
delirium tremors
rare withdrawal symptom when alcohol in blood drops suddenly; delirium, tremulous, hallucinations
180
alcohol and nicotine are cross-tolerant
nicotine can induce tolerance for the rewarding effects of alcohol and vice versa
181
prevalence of AUD
- 4.4% of US population met criteria for AUD in 2018
- 39.4% college-age adults report binge drinking
- 12.5% college0age adults report heavy-use drinking
- prevalence varies by gender, race, and education level
182
binge drinking
5 drinks in a short period of time
183
heavy-use drinking
5 drinks on the same occasion 5 or more times in a 30-day period
184
short-term effects of alcohol
- enters the bloodstream quickly through small intestine
- metabolized by the liver slowly at 1 ounce of 100 poof per hour
- effects vary by concentrations, which varies by gender, height, weight, liver efficiency, food in stomach
- size of drink defined by alcohol content
- interacts with several neurotransmitters
185
alcohol interacts with several neurotransmitters
- stimulates GABA receptors to reduce tension
- increases dopamine and serotonin to produce pleasurable effects
- inhibits glutamate receptors to produce cognitive difficulties
186
effects of high dose (0.08 blood alcohol content) of alcohol
- significant motor impairment
- difficulty monitoring errors and making decisions
187
long term effects of prolonged heavy alcohol use
- impaired digestion of food and absorption of vitamins
- cirrhosis of liver
- damage to the endocrine glands, brain, pancreas; heart failure, erectile dysfunction, hypertension, stroke, capillary hemorrhages
188
fetal alcohol syndrome (FAS)
- caused by heavy alcohol intake during pregnancy
- leading cause of intellectual disability among children
- 1-5% of children have a fetal alcohol spectrum disorder
- fetal growth slowed
- cranial, facial, and limb anomalies occur
189
prevalence of tobacco use disorder
- smoking rate declined by about 1/3 between 1990 and 2015
- continued decline from 2015-2018 among 18-25 year olds
- more prevalent among people with lower socioeconomic status
190
tobacco use disorder health consequences
- smoking remains the single most preventable cause of premature death in the US
- cigarettes also cause or exacerbate: emphysema, cancers of larynx, esophagus, pancreas, bladder, cervix, and stomach, cardiovascular disease, sudden infant death syndrome and pregnancy complications
191
secondhand smoke
- environmental tobacco smoke
- nonsmokers can suffer lung damage, possibly permanent, from extended exposure to cigarette smoke
-babies exposed during pregnancy are more likely to be born prematurely, have lower birth weights, and have birth defects
- children of smokers are more likely to experience upper respiratory infections, asthma, bronchitis, and inner-ear infections
192
cannabis use disorder prevalence
- higher among men than women
- no differences across racial and ethnic groups
- rates of daily use are on the rise
193
psychological effects of marijuana
- cannabinoids are the active ingredients in cannabis
- feelings of relaxation and sociability
- large doses --> rapid shifts of emotion; interferes with attention, memory, and thinking
- heavy doses --> hallucinations and panic; cognitive impairment
194
short-term physiological effects of marijuana
- difficult to regulate dosage (many people smoke more than intended waiting for effects)
- physical symptoms: bloodshot and itchy eyes, dry mouth and throat, increased appetite, reduced pressure within the eye, increased blood pressure
195
long-term physiological effects of marijuana
- damage to lung structure and function in long-term users
- effects on hippocampus
- impaired connectivity between dorsolateral PFC and amygdala during emotion regulation among users (vs. non-users)
- use can develop tolerance and withdrawal
196
therapeutic effects of marijuana
- reduces nausea and loss of appetite caused by chemotherapy
- can relieve discomfort associated with: cancer, glaucoma, chronic pain, muscle spasms, seizures, and discomfort from AIDS
197
opiates
made from opium plant; include opium, morphine, codeine, heroin
198
semi-synthetic opioids
- most of the prescription drugs derived from opium
- includes drugs made in a lab that are partially synthesized from chemical components of opium, including oxycodone, hydrocodone, hydromorphone, and oxymorphone
199
synthetic opioids
- fully manufactures in lab
- methadone, tramadol, fentanyl
200
opioids
- moderate doses relieve pain
- prescription pain medications among the most abused of all drugs
- Vicodin, Zydone, Lortab, Percodan, Tylox, OxyContin
201
heroin
- more common in men
- people most often start with taking prescription pain medicines before use
- increasing use of synthetic opioids like fentanyl have been leading to the most recent wave of deaths since 2013
202
opiate prevalence and consequences (prescription)
- most commonly abused opioids
- number of people seeking treatment continues to increase
- misuse is slightly higher in men
- misuse is higher among White Americans compared to other ethnic and racial groups
- nearly 91 people a day died from an opioid overdose in 2015
203
psychological and physical effects of opiates
- produce euphoria, drowsiness, and lack of coordination
- loss of inhibition, increased self-confidence
- severe letdown after about 4-6 hours
- Heroin and OxyContin --> intense feelings of warmth and ecstasy following injection
- stimulate receptors of the body's opioid system
- exposure to infectious agents (e.g., HIV, hepatitis) through intravenous drug us
204
opiate withdrawal
- may begin within 8 hours after high tolerance develops
- muscle pain, sneezing, sweating, tearfulness, yawning, resembles influenza
- within 36 hours, becomes more severe: uncontrollable muscle twitching, cramps, chills, flushing/sweating, elevated heart rate/blood pressure, insomnia, vomiting, diarrhea
- withdrawal lasts about 72 hours
205
stimulants
amphetamines, methamphetamine, cocaine/crackf
206
amphetamines
- Dexedrine, Adderall
- trigger release and block reuptake of norepinephrine and dopamine
- taken orally or intravenously
- a person becomes alert, euphoric, outgoing, feels boundless energy and self-confidence
- high doses can lead to nervousness, agitation, confusion, suspiciousness, hostility
- tolerance can develop after only 6 days of use
207
methamphetamine
- most commonly abused stimulant drug
- "crystal meth" or "ice"
- 5.4% of people report ever having used in 2015
- men tend to abuse more than women
- used more often in small towns than in cities
- can be taken orally, intravenously, or intranasally (snorting)
- immediate high, or rush, that can last for hours
- good feeling crashes and person becomes agitated
- cravings are strong, lasting several years after use is discontinued
- use is associated with brain damage: affects dopamine and serotonin systems, reductions in brain volume, damage to areas associated with reward and decision making
208
cocaine
- can be snorted, smoked, swallowed, or injected
- used predominantly in urban areas and by men
- acts rapidly on the brain
- blocks reuptake of dopamine in mesolimbic areas
- induces pleasurable states; increased sexual desire, self-confidence, stamina
209
crack
- form of cocaine developed in the 1980s
- rock crystal that is heated, melted, and smoked
- cheaper than cocaine
- acts rapidly on the brain
- blocks reuptake of dopamine in mesolimbic areas
- induces pleasurable states; increased sexual desire, self-confidence, stamina
210
overdose (OD)
chills, nausea, insomnia, paranoia, hallucinations, possibly heart attack and death
211
hallucinogens
- used more often by men and European Americans
- LSD
- no evidence of withdrawal, but tolerance develops rapidly
- affects serotonin system
- effects take place within 30 minutes, lasts up to 12 hours
- hallucinations, sense of time, mood swings, expanded consciousness
- flashbacks
212
flashbacks
visual recurrences of perceptual experiences after effects of drug have worn off
213
ecstasy (molly, MDMA)
- stimulant and psychedelic
- taken in a pill or powder form
- average age of first use: 21
- acts primarily on the serotonin system
- increases feelings of intimacy, insight, positive emotions, self-confidence
- can also cause muscle tension, nausea, anxiety, depression, confusion, depersonalization
214
phencyclidine (PCP)
- hallucinogen
- angel dust
- used more by men
- causes severe paranoia and violence
- coma and death are possible
215
genetic influences on SUDs
- relatives and children of problem drinkers have higher-than-expected rates of alcohol use disorder
- heritability estimates range 0.40-0.60
- greater concordance in MZ than DZ twins: alcohol use disorder, smoking, heavy use of marijuana, drug use disorders in general
- genetic and shared environmental risk factors appear to be the same no matter what the drug
- heritability for at-risk adolescents is higher for those with: many peers who drink, a best friend who also smoked and drank, when the "popular crowd" smoked
- tolerance for larger quantities of alcohol may be inherited
216
neurobiological influences on SUDs
- nearly all drugs stimulate the dopamine system, particularly the mesolimbic parthway; linked to pleasure and reward; positively reinforcing
- people also take drugs to avoid the bad feelings; avoidance of withdrawal symptoms, negatively reinforcing, explains frequency of relapse
- vulnerability model vs. toxic effect model
217
incentive-sensitization theory of SUDs
- distinguish wanting (craving for drug) from liking (pleasure obtained by taking the drug)
- overtime, liking for drugs decreases, but wanting remains intense
- dopamine system becomes sensitive to the drug and the cues associated with the drug
- craving is associated with future use
218
psychological influences on SUDs - valuing short term over long term
- immediate (short-term) vs. delayed (long-term) rewards
- people dependent on substances discount delayed rewards more steeply than do people who are not dependent
- valuing immediate vs. delayed rewards recruits different brain regions
- delayed reward --> prefrontal cortex
- immediate reward --> amydala, nucleus accumbens
219
psychological influences on SUDs - risky decision making
- people with drug or alcohol use disorders are more prone to make risky decisions that can lead to use of substances or drug-seeking behavior
- low tolerance for ambiguous risks predicts opioid use relapse
- neural regions supporting delay discounting and decision making have been identified
220
psychological influences on SUDs - emotion regulation
- mood alteration --> enhances positive feelings or diminishes negative ones
- people with substance use disorders may be less successful in regulating negative emotions
- substance use as an emotion regulation tool: dampen down thoughts of rejection in social situations, provide relief or distraction from negative emotions, increase positive emotions when bored
221
psychological factors of SUDs - expectancy
- expectancies about alcohol and drug effects
- people who expect alcohol to reduce stress and anxiety are most likely to drink
- expectancies about a drug's effect predicted increased drug use in general
- expectancies about social effects may be particularly impactful among adolescents and young adults
222
psychological factors of SUDs - personality
- high levels of negative emotionality or neuroticism
- persistent desire for arousal and positive affect
- low constraint (low levels of harm avoidance, conservative moral values, and cautious behavior)
223
sociocultural factors of SUDs
- alcohol is the most commonly abused substance worldwide
- cultural attitudes and patterns of drinking influence the likelihood of drinking heavily and therefore of abusing alcohol
- men consume more alcohol than women
- parental alcohol use
- marital discord
- lack of parental support, monitoring
- social networks, media, and advertisements
224
alcoholics anonymous (AA)
- largest self-help group for problem drinkers
- regular meetings provide support, understanding, and acceptance
- promotes complete abstinence
225
therapy for AUDs
CBT
- identifying thoughts and beliefs that facilitate substance use
- practicing alternate thoughts and behavioral strategies to facilitate non-use
- identifying cognitive erors associated with relapse
couples therapy
- combines skills covered in individual CBT with a focus on dealing with alcohol-related stressors together as a couple
- more effective than individual treatment approaches
226
interventions for AUDs
- motivation interventions: increasing intrinsic motivation by raising awareness of a problem, adjusting self-defeating thoughts, and increasing confidence in ability to change
- psychoeducation: indvidualized feedback on person's drinking in relation to community and national averages, education about effects of alcohol
227
controlled drinking for AUDs
- guided self-change
- people have more control over their drinking than they believe
228
medications for AUDs
- Antabuse (disulfiram): produces nausea and vomiting if alcohol is consumed
- Naltrexone (blocks high)
- Acamprosate (facilitates abstinence)
- most effective when combined with CBT
229
treatment for smoking
- laws prohibiting smoking in most public places
- physician's advice
- reduce nicotine intake gradually over a few weeks
- nicotine replacement: gum, patches, inhalers, e-cigarettes
230
treatment of drug use disorders
- substance use disorders are typically chronic, and relapse occurs often
- detoxification central to treatment
- CBT: learn how to avoid high-risk situations, recognize triggers, and develop alternatives to use
- contingency management: vouchers that can be traded for desirable goods are given to users who abstain
- motivational enhancement therapy
- self-help residential homes
231
treatment of drug use disorders - opioids
- opioid substitutes: syntheti narcotics, methadone, bupreophine; used to wean off opioids; person does not experience euphoric high; dropout is high (bad side effects)
- opioid antagonists: Naltrexone; person is gradually weaned from heroin or pain medication
232
prevention of tobacco use
- programs to discourage young people from experimenting with tobacco --> The Truth Initiative
- statewide comprehensive tobacco control programs appear effective at reducing teenage smoking
233
prevention of substance use
- the measures that hold promise for persuading young people to resist smoking may also be useful in dissauding them from trying other drugs and alcohol
- breif family interventions
234
DSM-5 criteria of anorexia nervosa
- restriction of behaviors that promote healthy body weight
- typically body weight is significantly below normal for a person's age and height
- strong fear of weight gain or behavior that interferes with weight gain
- distorted body image or sense of body shape
235
anorexia nervosa
- weight loss is typically achieved through dieting (or not eating)
- fear of gaining weight is not reduced by weight loss
- the person believes there is no such thing as "too thin"
- overestimate their body size
- will choose a thin figure as ideal
236
subtypes of anorexia nervosa
restricting type, binge-eating/purging type
237
restricting type of anorexia nervosa
weight loss is achieved by severely limiting food intake
238
binge-eating/purging type
the person has also regularly engaged in binge eating and purging
239
prevalence of anorexia nervosa
- usually triggered by dieting and stress
- at least 3 times more frequent in women than men
- in men, focus may be more on muscularity in addition to lean body shape
- often comorbid with depression, OCD, phobias, panic, personality disorders
- suicide rates are high
240
age of onset of anorexia nervosa
early to middle teenage years
241
physical consequences of anorexia nervosa
- low blood pressure, heart rate decrease
- kidney and gastrointestinal problems
- loss of bone mass
- brittle nails, dry skin, hair loss
- lanugo (a fine, soft hair) may develop
- altered levels of potassium and sodium electrolytes
242
prognosis of anorexia nervosa
- 50-70% eventually recover
- relapse common
- life-threatening
243
DSM-5 criteria of bulimia nervosa
- repeated episodes of binge-eating
- repeated compensatory behaviors to prevent weight gain (e.g., purging, fasting, excessive exercise, use of laxative and/or diuretics)
- body shape and weight are extremely important for self-evaluation
- noe underweight
244
binge episode
- an excessive amount of food consumed in a short period of time
- a feeling of losing control over eating
245
binge eating in bulimia nervosa
- binge episodes
- typically occurs in secret
- may be triggered by stress, negative emotions, or negative social interactions
- avoiding a craved food can later increase likelihood of binge
- reports of losing awarenes or dissociation
- shame and remorse often follow
246
compensatory behavior in bulimia nervosa
- feelings of discomfort, disgust, and fear of weight gain lead to inappropriate compensatory behavior
- attempt to undo the caloric effects of the binge
- vomiting, laxative, and diuretic abuse, fasting, excessive exercise are used to prevent weight gain
- binge/purge episode must occur at least once a week for 3 months
247
prevalence of bulimia nervosa
- 90% of people with bulimia nervosa are women
- 1-2% women
- typically overweight before onset and symptoms begin while dieting
- comorbid with depression, personality disorder, anxiety, substance use disorders, conduct disorder
- suicide rates are higher than in general population, but much lower than in anorexia nervosa
248
age of onset for bulimia nervosa
late adolescence or early adulthood
249
physical consequences of bulimia nervosa
- potassium depletion from purging
- laxative use depletes electrolytes, which can cause cardia irregularities
- vomiting may lead to tearing of the tissue in the stomach and throat
- loss of dental enamel from stomach acids in vomit
- mortality rate higher than other disorders
250
prognosis of bulimia nervosa
- ~75% recover
- 10-20% remain fully symptomatic
- early intervention linked with improved outcomes
- poorer prognosis when depression and substance abuse are comorbid or when more severe symptomatology
251
key difference between bulimia and anorexia
weight loss
- anorexia: weight is low
- bulimia: weight is normal or overweight
252
DSM-5 criteria for binge eating disorder
- repeated binge eating episodes (at least 1x/week for at least 3 months)
- the binge eating episodes must include several additional features beyond those included in bulimia (eating fast, eating even if not hungry, eating past feeing full, feeling bad about eating so much)
- no compensatory behavior is present
253
prevalence of binge eating disorder
- typically associated with obesity and history of dieting
- often comorbid with mood disorders, anxiety disorders, ADHD, conduct disorder, and substance use disorders
- more prevalent in women
- more prevalent than anorexia or bulimia
254
risk factors for binge eating disorder
childhood obesity, critical comments about being overweight, weight-loss attempts in childhood, low self-concept, depression, childhood physical or sexual abuse
255
physical consequences assocaited with obesity
- increased risk of type 2 diabetes
- cardiovascular problems
- chronic back pain
- headaches
256
physical consequences outside of obesity of binge eating disorder
- sleep problems
- anxiety/depression
- irritable bowel syndrome
- early onset of menstruation in women
257
prognosis of binge eating disorder
research so far suggests between 25-82% recover
258
binge eating disorder vs. anorexia and bulimia
- absence of weight loss (unlike in anorexia)
- absence of compensatory behaviors (unike in bulimia)
259
genetic influences on eating disorders
- first-degree relatives with eating disorders
- higher MZ concordance rates for both anorexia and bulimia
- key features of eating disorders are heritable
260
neurobiological influences on eating disorders
- hyothalamus
- abnormal patterns of activity in response to food stimuli
- serotonin --> related to feelings of satiety; low levels of serotonin
- dopamine --> key role in "wanting" or craving for food
261
cognitive behavioral and emotion influences on anorexia nervosa
- body-image disturbance powerfully reinforces weight loss
- behaviors that achieve or maintain thinness are negatively reinforced by the reduction of anxiety about gaining weight, positively reinforced by comments from other and by the sense of mastery/self-control
- perfectionism and personal inadequacy lead to excessive concern about weight
- criticism from family and peers regarding weight
262
cognitive behavioral and emotion factors of bulimia nervosa
- self-worth strongly influenced by weight and shape
- lapses in rigid restrictive eating rules escalates into a binge
- after binging, disgust with oneself and fear of gaining weight lead to compensatory behavior
- purging temporarily reduces anxiety about weight gain
- this cycle lowers a person's self-esteem, which triggers further binging and purging
263
cognitive behavioral factors of binge eating disorder
- typically binge when under stress or experience negative emotions
- neuroticism
- binging may function as a way to regulate negative emotion
- binges associated with negative emotion just prior to binging which may decrease after a binge despite no change in positive affect
264
sociocultural influences on binge eating disorder
- cultural ideals
- dieting has become more prevalent
- higher BMI and body dissatisfaction related to higher risk for developing eating disorders
- stigma associated with being overweight
- unrealistic media portrayals
265
gender influences on binge eating disorder
- objectification of women's bodies
- aging and changes in life roles associated with decreases in eating disorder symptoms
266
cross-cultural factors of eating disorders
- as countries become more like Western cultures, eating disorders increase
- bulimia more common in industrialized societies than non-industrialized ones
267
racial and ethnic differences in eating disorders
- greater incidence of eating disturbances and body disatisfactiom among white women
- no differences in actual eating disorders
268
personality influences on eating disorders
- after severe restriction of food intake: preoccupation with food, fatigue, poor concentration, lack of sexual interest, irritability, moodiness, and insomnia
- before eating disorder: body dissatisfaction, perfectionism
269
characteristics of families of those with eating disorders
self-reports of peopel with eating disorders indivate high levels of family conflict
270
medications for eating disorders
- often treat bulimia with antidepressants (comorbid with depression, dropout and relapse rates high)
- little success for anorexia
271
psychological treatment of anorexia nervosa
- immediate goal is to increase weight to avoid medical complications and avoid death
- second goal is long-term maintenance of weight gain
- CBT --> alter distorted cognitions about weight and eating
- family-based therapy (FBT)
272
psychological treatment of bulimia nervosa
- CBT
- interpersonal therapy
273
psychological treatment of binge eating disorder
- CBT
- interpersonal therapy
274
prevention of eating disorders
- psychoeducational approaches
- help resist or reject sociocultural pressures to be thin
- risk-factor approach
275
distal and stable risk factors for suicide risk
- distal (distant/in the past) and stable (consistent)
- risk doesn't change and is always there at a certain level
- flat and consistent across time
- potentially occurs years before the outcome
276
proximal and dynamic risk factors for suicide risk
- proximal (could fluctuate right before a suicide attempt) and dynamic (changes over time within a day or over a year, etc.)
- occur much closer in time to the outcome of interest
- fluctuate over time
PSYC 360: Psychological Disorders
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