Abnormal Psych, Eating and Impulse control disorders
Abnormal Psych, Eating and Impulse control disorders Psych 385
U of L
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This 8 page Class Notes was uploaded by Caroline Pirtle on Monday April 18, 2016. The Class Notes belongs to Psych 385 at University of Louisville taught by Dr. Irby in Fall 2015. Since its upload, it has received 6 views. For similar materials see Abnormal Psychology in Psychlogy at University of Louisville.
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Date Created: 04/18/16
Eating Disorders and Impulse Control Disorders Monday, October 19, 2015 1:55 PM I. Anorexia Nervosa - DSM5 criteria a. Restriction of food that leads to very low body weight b. Intense fear of gaining weight or becoming fat c. Disturbance in the way in which one's body weight or shape if experiences, undue influenced of body weight or shape on self-eval, or denial of the seriousness of the current low body weight. i. Subtypes: 1. Restricting type: has not regularly engaged in binge-eating or purging behavior; may also exercise a lot; tendency to have co variants with obsessive compulsive disorder 2. Binge-eating/purging type: the person has regularly engaged in binge-eating or purging behavior - not necessarily exercising; excreting out of the body before can be metabolism a. Perceive they've overeaten because what they are used to is inaccurate. ii Health consequences 1 Heart problems 2 Metabolic problems 3 Electrolyte imbalance 4 Blood problems a. anemic 2 Dental problems a. Teeth become loose 2 Endocrine problems a. Lose menstrual cycle b. Salivary glands swell 2 Gastrointestinal problems a. Constipation b. Acids II Bulimia Nervosa - DSM4 criteria a Recurrent episodes of binge eating i Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances b Recurrent compensatory behavior in order to prevent weight gain (vomiting, laxatives, excessive exercise) c The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months d Self-eval is unduly influences by body shape and weight e Does not occur exclusively during anorexia nervosa i Health consequences 1 Dental problems 2 Tends to onset in adolescence (later than anorexia) I Binge Eating Disorder Criteria: a Recurrent binge eating episodes b Binge eating episodes include at least 3 of the following: i Eating more quickly than usual ii Eat until over full iii Eating large amounts even if not hungry iv Eating alone due to embarrassment over food quantity v Feeling bad after binge b No compensatory behavior present II Etiology a Biological factors i Genetic ii Abnormalities in the hypothalamus 1 Under activated on a chronic basis and anatomically shrink 2 Do not know whether this is a chicken or egg effect ii Low levels of serotonin and dopamine 1 Bulimia and binge eating more common when anxiety and depression are underlying factors b Sociocultural factors i Cultural norms and standards for thinness ii Socializing process for women iii SES and ethnic factors iv Family interaction patterns 1 Greater likely of having a history of conflict in the family 2 Losing temper or crying is discouraged - not paying attention to person when crying 3 Message to not let negative feelings show - perfectionism b Psychological factors II Treatment a Anorexia i Often requires multiple approaches, including hospitalization ii Primary concern is weight gain; coping skills iii Family therapy iv Cognitive therapy v Little evidence for pharmacological treatments b Bulimia i Cognitive-behavioral therapy ii Self-monitoring iii Interpersonal therapy iv SSRI's II Temperament a A biological predisposition in their general mood and behavior i Three types 1 Easy a. Easily satisfied; easy to raise - attach well to caregivers, compliant, develop regular sleep/wake/eating patterns; love cuddling; smile more often 2 Slow to warm a. Cautious; do well in routine as long as routine isn't interupted (fire engines, temp changes); shy, timid 2 Difficult a. Intense emotional reactions to stimuli; overreact; tend to tantrum over small things and not to reveal a lot of positive emotion; insatiably demanding; inflexible; may not like the clothes on their skin or labels; hugging makes tantrum worse ii Common behaviors 1 Argumentative, angry, and resentful 2 Easily annoyed by others and annoying to others 3 Refusing to comply with rules or requests and blaming others for problems 4 Coercing caregivers 5 Delinquency II Oppositional-defiant disorder a Essential features: a recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward authority figures that persists for at least 6 months. b Onset and course: usually evident before age 8, starting at home then potentially translating to other settings, with increasing symptoms over time. c Prevalence: 2-16% of children meet this criteria, with males more prevalent before puberty and more likely to have confrontational behaviors, while females may be under-recognized due to tendency to present more passive-resistant behaviors. II Conduct disorder a Essential feature: repetitive and persistent behavior pattern violating the basic rights of others or conventional social norms, in at least three of these areas, in last 12 months, with at least one type of violation in last 6 months II Intermittent Explosive Disorder a Essential Features: failure to control aggressive impulses (verbal = 2x per week in 3 months; physical = 3 episodes in 12 months b Prevalence and prognosis II Impulse control disorders a Kleptomania - urge to steal b Pyromania - fire setting II Somatoform Disorders -- The mind-body connection a Hysterical Neuroses - the case of "Anna O" i Physical expression of psychological disturbances ii Origins of " the talking cure" - psychoanalysis iii Today they are called conversion disorders b Conversion disorder i Diagnostic criteria: 1 Multiple sxs in voluntary motor/sensory functions 2 Sxs associated with psychological factors. a. Pattern of onset or worsening with stress 2 Sxs not intentionally produced or feigned 3 Sxs not medically explainable a. Inconsistent with neuroanatomy/function 2 Sxs cause impairment/ distress a. La belle indifference i. Be severely impaired but not distressed about it ii. Symptoms alleviate stress ii Symptoms: 1 Motor sxs -- swallowing difficulties 2 Sensory sxs -- loss of sense of touch, may feel fingers are numb, may complain of blindness or deafness 3 Seizure -- very dramatic of muscular compulsions but may look like loss of consciousness but without abnormal EEG; looks like one but isn't one 4 Mixed presentation -- many different types of symptoms ii Prevalence: 1 Rare, 3% (mental health clinics) 2 Up to 14% (medical settings) 3 Female > male (10:1) 4 Lower SES, rural/developing areas, less education ii Course: 1 Onset b/w ages 10-30 -- usually acute 2 Episodes typically last up to 2 weeks 3 Recurrence of episodes common ii Better outcomes when source is identifiable. Tx begins quickly, sxs don't involve seizures/tremors b Somatic symptoms disorder: i Diagnostic criteria: 1 At least one somatic symptoms that is distressing or disruptive of daily functioning 2 Excessive thoughts, feelings and behaviors related to somatic sxs or health concerns, as evidenced by: a Health-related anxiety b Disproportionate and persistent concerns about medical seriousness of sxs c Excessive time and energy devoted to health concerns 2 Duration at least 6 months 3 Prevalence: a Rare, females > males (2%:.2% b 20% of female first degree relatives meet criteria c Male first degree relatives have increased risk for APD, SA d Lower SES and education 2 Course: a Chronic, but fluctuating, with little remission of sxs 2 Typically don't seek psychological treatment, difficulty connecting emotional stress with physical sxs. b Pain disorder i Diagnostic criteria: 1 Report of pain in multiple areas 2 Pain is significantly distressing/impairing of function 3 Pain is not intentionally produced or feigned 4 Psychological factors effect pain experience a Onset b Intensity c Maintenance ii Prevalence: 1 Experience of pain is common 2 Chronic pain is more impairing 3 Pain disorder is rare maladaptation to pain 4 Associated with SA, Mood/Anxiety b Illness anxiety disorder (hypochondriac) i Diagnostic criteria: 1 Preoccupied with having or acquiring a serious disease 2 Up to 5% of general pop b Differential diagnosis i Intentionally producing false/exaggerated sxs for primary gain ii Factitious disorder: 1 False/exaggerated sxs for secondary gain a (obtaining attention/symathy by being in "sick role") 2 Munchausen's syndrome a Inducing illness (even death) in others I Dissociative Disorders a Dissociation = "splitting off" of psychological components that are normally integrated into consciousness b Absence of demonstrable brain damage c Typically a "coping" response II Dissociative Amnesia a Partial or total forgetting of past experience b Not attributable to brain damage i Anterograde ii Selective iii Less distressing iv Retain orientation and ability to learn v Forgotten events recoverable II Depersonalization disorder a Alterations in mid-body perceptions b Feeling "unreal" "robotic" or like body doesn't belong to them c Derealization = feeling that experiences and events are unreal or not really happening, with emotional detachment d Accompanied by distress and intact reality testing capacity II Dissociative Identity Disorder (Multiple personality) a Fragmentation of personality structure into 2 or more distinct identities b At least two identities take control of behavior c Types of identities: i Host = original identity ii Alters = later developed identities iii Child alters (85%) iv Different age alters (15%) v Functional alters (30%) vi Opposite sex alters (50%) 1 Tend to be protectors for the female alters 2 Respond to bulleys and are assertive 3 Female versions may be sexual in male hosts ii Persecutory alters (29%) iii Polar opposite alters (80%)
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