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Abnormal Psychology-Second Test

by: aiy0001

Abnormal Psychology-Second Test PSCY 3560

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The second test goes covers: Chapter 6: Anxiety Disorders Chapter 7: Mood Disorders & Suicide Chapter 8: Personality Disorders + Eating Disorders
Abnormal Psychology
Rebecca Fix
Class Notes
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This 19 page Class Notes was uploaded by aiy0001 on Sunday August 21, 2016. The Class Notes belongs to PSCY 3560 at Auburn University taught by Rebecca Fix in Fall 2016. Since its upload, it has received 7 views. For similar materials see Abnormal Psychology in Psychology (PSYC) at Auburn University.


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Date Created: 08/21/16
Abnormal Chapter 6: Anxiety Disorders Fear v. Anxiety Fear  Basic emotion  Involves fight or flight response of the autonomic system (amped up or relaxed) o Behave in this way too (get out or fight)  Present focused  “I’m going to die”-emotional reaction, in the moment  Panic Attack: fear response in the absence of actual threats Anxiety  More future focused o “I’m worried that I won’t do well on this test”  Complex blend of unpleasant emotions and cognitions  Longer stress response-adrenaline is produced a slightly lesser rate  Behavioral: Avoiding the situation  Can be adaptive-problem occurs when it is excessive What Can Define an Anxiety Disorder?  Must be out of proportion to the dangers that are truly faced o Seeing a cute tiny puppy could be perceived to someone as monstrous o Severe enough to cause distress or impairment  Is it holding them back? o Fear response still exists even when a stimulus is not present Specific Phobias: Characterized by a strong and persistent fear that is triggered by a specific stimulus + avoidance The core fear is the object or situation Subtypes of Specific Phobias  Animal  Natural Environment-disaster related  Blood Injection Injury-highly genetic; fainting response-don’t want to relax them because they’re already about to faint!  Situational  Other-could be about bodily functions or even choking or dying Lifetime prevalence: 12% About equal in women and men…BUT more animal type cases in women (90-95%) In women, less than a 2:1 ratio for blood injection Comorbidity: 75% have at least one other specific fear Development: animal and blood injection types in early childhood and others develop in adolescence or early adulthood Causal Factors of Specific Phobias  Psychological o Behaviorism/learning  Classical and operant condition  Individual differences based on experiences o *Evolutionary preparedness  You wouldn’t think people would be afraid of neutral stimuli  Biologically trained to be more afraid of stimuli that could potentially be a threat to us Treatment of Specific Phobias  Exposure Therapy o Becoming comfortable with what you’re afraid of by taking baby steps  Flooding o One session where you become in full contact with their fear  If you’re scared of snakes, you’re touching and holding the snake!  “Ripping the band aid off”  Medications but they’re not very effective o Could interfere with anxiety medicine Social Anxiety Disorder: Characterized by disabling fears of one or more specific social situations Core fear: negative evaluation Lifetime prevalence: 12% Gender ratio: 3:1-2:1 (this is female to male) Comorbidity Less than 50% have another anxiety disorder in lifetime About 50% have major depression About 33% have alcohol abuse Higher unemployment and lower socioeconomic status When does this develop? Late adolescence Causal Factors of S.A.D  Psychological o Behavioral: direct and observational learning o Cognitive biases  Picking faces depending on what they’re feeling  Brought up in families where the parents are uncontrollable or unpredictable  Could be brought up to see neutral faces as negative Treatment of S.A.D  Exposure Therapy o Targeting and changing thoughts about certain situations o Breaking down which thoughts are actually just experiences o Examine for evidence for against those perceived thoughts o Reframing thoughts to be less biased and more accurate  Medications o Antidepressants-effective but not long-term Panic Disorders: Recurring panic attacks that come out of the blue AND FEARS of having additional panic attacks Core fear: fear itself (the fear of fear) Females are more likely to develop a panic disorder than men Comorbidity: substance abuse-looking to feel more relaxed in front of people Could down the road be diagnosed with agoraphobia Age of onset: early adulthood Causal Factors of Panic Disorder  Cognitive Theory o Perceived Threat-physiological change in body; notice small change and become sensitive and worried (shortness or breath, fast heart beat) o Apprehension of worry o Body sensation o Interpretation of sensation as catastrophic (“this means I’m going to have a panic attack”) o Placebo effect-either told you the pill was going to affect you or not  Anxiety Sensitivity: environment someone grew up in  Perceived Control  Safety/Avoidance Behaviors-carrying around pills to be on the safe side  Cognitive Biases that maintain Treatment of Panic Disorder  Medications o Antidepressants-daily o Benzo. Only when really needed  Cognitive-Behavioral Therapy o Exposure-getting someone to have a panic attack o Cognitive Restructuring Panic Attack: A discrete period of intense fear in which 4 of the following symptoms develop abruptly and peak within 10 min. (however can last longer)  Palpitations of pounding  Sweating  Trembling of shaking  Shortness of breath  Feelings of choking  Derealization-things that aren’t real  Depersonalization-feeling like you’re outside of yourself  Fear of losing control or dying  Numbness  Chills or hot flashes  Feeling lightheaded  Chest pains  Nausea or abdominal distress Timing of First Panic Attack  Frequently follows feelings of stress or highly stressful life circumstance  Can have a single panic attack but not necessarily a panic disorder  Heart attack concerns Agoraphobia: Fear of situations in which escape might be difficult if you have a panic attack or other embarrassing symptoms; situations are avoided with distress or a panic attack; worried about having panic attacks as well and associate places with places they have had attacks Common Situations  *Crowds, theaters, malls, parking lots, cars, bridges, standing in line, elevators, airplanes  Home alone-What is no one is home if I actually do have a panic attack? Generalized Anxiety Disorder: Characterized by excessive and unreasonably anxiety or worry about many different aspects of life Core Fear: EVERYTHING-characterized by worry Prevalence: 6% in lifetime Tends to vary, could have it for a year and find that you don’t have anxiety anymore Comorbidity: very high! Depression or other mood disorders Causal Factors of GAD  Perceptions of uncontrollability and unpredictability-if their loved one is driving in a bad storm, might call constantly o This is normal, but people with GAD take it a step further o Worry  Believe that worry is a good thing-calling someone will get them home safe  Worry is a way of coping with their anxiety  Strong biases and worries about threat Treatment for GAD  Medications  Cognitive Behavioral Treatment o Muscle relaxation-squeeze hard, relax  Tricks your mind into thinking you’re more relaxed  Cognitive Restructuring-there are worse things that could happen Obsessive Compulsive Disorder: Don’t need to have Obsessions-Thoughts that are upsetting; soon develop rituals to stop thoughts  Recurrent and persistent  Getting in the way of every day things  Common obsessions o Contamination o Harming oneself or others o Pathological doubt-negative thoughts about themselves o Need for symmetry-when it takes a lot of time to organize o Sexual obsessions o Religious obsessions Compulsions-The rituals  Repetitive behaviors or mental acts-driven to perform acts in response to an obsession  Aimed at preventing or reducing the distress they’re experiencing  Common compulsions o Cleaning o Checking (certain time of day) o Repeating o Ordering or arranging o *Counting Not a large discrepancy between females and males Age onset: late adolescence and early adulthood (when people are starting to have more independence) Comorbidity: elevated rates of divorce and unemployment Causal Factors of OCD  Learning o Anxiety is first conditioned and then maintained through avoidance  Cognitive Factors o Difficulty in suppressing thoughts o Intrusive thoughts-claims responsibility (if my room is pristine my dad won’t beat me) o Specific distortions Treatment for OCD  Behavioral and cognitive behavioral is very common o Exposure and response prevention  Always making sure they’re in a safe situation o Cognitive restructuring o 50-70% reduction in symptoms Body Dysmorphic Disorder: Perceiving that someone’s specific body parts are ugly Ex. Michael Jackson High in hair-more males Nose shape Skin (acne) Checking that specific body part a lot and obsessing over it Avoidance of activities-scared of social situations Reassurance seeking Comparing themselves to others in an obsessive manner Engaging in extreme lengths of grooming to cover up their perceived flaw *Thoughts of suicide Men=women Starts in adolescence High rates of depression and suicidal behavior Relationship to eating disorders as well as OCD Report symptoms of psychosis (delusions) High in white people Chapter 7: Mood Disorders & Suicide Mood Disorders  Two key moods are mania and depression o Unipolar: person experiences only depressive disorders o Bipolar: person experiences both manic and depressive episodes Types of Moods  Depressive Episodes o Extreme sadness and gloominess  Manic/Hypomanic Episodes o Intense/unrealistic feelings of excitement and euphoria o Hypomanic is not as extreme as Manic Major Depressive Disorder: Persistent down or depressed moods occurring more says than not--Unipolar  Intense and episodic  Emotional o Sad mood, anhedonia  Physiological/Behavioral o Appetite change (gain or lose wait) o Sleep disturbances (can’t fall asleep or sleep too much), o Psychomotor disturbance (biting skin around fingers, o Lots of motor activities), fatigue  Cognitive o Inappropriate guilt and feelings of worthlessness o Difficulty concentrating, indecisiveness o Thoughts of suicide or actual attempts  Recurrent v. Single episode o Recurrent: More than one single episode  Course of MDD o Depressive episodes are time limited (6-9 months on average) o Likelihood of recurrence increases as number of MDE’s increase  Mind is going to turn to what it is used to doing  3 R’s o Remission: Normative mood, not experiencing depression  Once it has been 2 months or longer o Relapse: Return of symptoms within a short period of time  When medications are discontinued for a bit o Recurrence: Disorder may go away for years but then another significant event happens and the it comes back  Epidemiology o Prevalence: 17% over lifetime  Increased over the last 2 decades-Getting better at diagnosing this, culture plays a big role  Prevalence by race and ethnicity  Higher rates of MDD among minorities o White: internal o Other: External –all due to biases! o Different stressors o Different symptomatology: Might present symptoms differently o Gender ratio: More females than males (adolescence and adulthood) o Age: more difficult to detect depression in late adulthood- may be due to other health related illnesses (i.e. dementia) o Comorbidity: Anxiety disorders, substance abuse, eating disorders, personality disorders Persistent Depressive Disorder (Dysthymia)—Unipolar  Some people have mild depression consistently (common) and some meet the full criteria for MDE the whole time  Symptoms must persist in a child for 1 year and an adult for 2 years  Not as intense as MDD (doesn’t go up very often) Causal Factors for Both Unipolar Disorders (MDD & PDD)  Biological Factors o Genetic influences o Neurochemical  Monoamine Theory: Serotonin and Norepinephrine are our motivation  Dopamine Theory: What causes us to have pleasure; why drugs and some food our so powerful  Hormonal: stress response in accordance with cortisol levels  Neurophysiological factors: right prefrontal cortex controls negative emotions whereas left prefrontal cortex controls positive emotions o Biological Rhythms  Sleep  More REM, less deep sleep  More susceptible to developing a disorder  Sunlight/seasons  Seasonal Affective Disorder o Atypical features (Body is hibernating more)  Psychological Factors o Stressful life events  Might place blame on themselves for something that happened o Personality factors  Neuroticism  Low affect-unenthusiastic, flat, bored, therefore, more at risk for perceiving the world in a more depressed way o Cognitive Theories  Hopelessness Theory: Perception that one has no control over what is going to happen and certainty that bad outcomes will occur  Ruminative Response Styles Theory  Stewing or focusing so intensely on how they feel and why they feel a certain way Interpersonal Factors for MDD  Lack of social support  Poor social skills (ties in with lack of social support)  Relationship distress (tend to carry those experiences with us and think that kind of situation will happen again)  These factors both precede onset of depression and are worsened by depression  Related to high rates or relapse and recurrence Treatments  Electroconvulsive Therapy (ECT) o Not the best long term fix o For severe depression and non responders  Transcranial Magnetic Stimulation (TMS) o Pulsating magnetic fields stimulate a certain area  Bright light therapy o Originally used for seasonal affective disorder Treatment: Psychotherapy  Cognitive Behavioral Therapy o Focusing on the here and now o As effective as medications and better at preventing relapses and recurrences o What happened? o What did you think? o Consequences? o What else could you think? o Reaction after new thoughts?  Behavioral Activation o Very hard to convince someone who doesn’t want to do anything! BUT is it very effective and as effective as CBT o Refers to increasing activities and interactions  Interpersonal Therapy o Identifies maladaptive interaction patterns with others (“You reacted like this towards me—the therapist—maybe you act like this towards others so let’s see how we can work on this”) Bipolar Disorder Mood episode: intense emotional states Manic episode: overly joyful and overexcited state  Elevated, expansive, mood lasting one week  3 or more of: o Inflated self-esteem, grandiosity (feeling like Jesus) o Decreased need for sleep o More talkative, pressured speech  Racing thoughts (everything I’m thinking is really important so let’s just say it all now) o Easily distracted and irritated o Increased goal directed activities or psychomotor agitation o Most problematic: engaging in very risky behavior, impulsiveness, hospitalization, upset about not being in their manic state anymore  Why it is difficult for them to stay on their medication Hypomania  Same as manic except: o Lasts at least 4 days o Behavior is noticeable by others but not severe enough to cause marked impairment in functioning Bipolar I-DSM 5 Criteria  Presence or history of one or more manic episodes  Clinically significant distress or impairment  Usually have a history of at least one depressive episode (but not required for BP) Bipolar II DSM Criteria  Presence or history of one or more MDE’s  Presence or history of one or more Hypomanic episodes  No history of a manic episode  Clinically significant distress or impairment *Cyclothymic Disorder Criteria  Numerous periods of hypomanic symptoms for at least 2 years  Don’t have MDE’s Prevalence of BP  Prevalence: Very rare! 2-3%  Gender ratio: 1:1 men to women  Age: displays symptoms in late adolescence (average age is 22)  Episodic (can fluctuate)  Comorbidity: substance abuse Bipolar v. Major Depressive Disorder  Manic episodes: For BP-tend to be much shorter than depressive episodes  Depressive episodes: For BP-Tend to be more severe than unipolar depression and often have: o Greater mood labiality o More psychotic features o More substance abuse (lots of variability) o Greater psychomotor retardation (pacing, wringing hands, biting lips)  Overall shorted episodes than MDD but more episodes during their lifetime o 3-4 episodes within 1 year  Prognosis: MDD is much more easy to treat because it can go into remission and therefore just go away Bipolar Disorder Biological Factors  Genetic Factors o One of the most heritable disorders o No single gene is responsible  Neurochemical factors o Elevated levels of norephinephrine and dopaminergic  Hormonal factors o Elevated cortisol levels during depressive episodes o Thyroid hormone can precipitate manic episodes  Biological rhythms o Disruptions in sleep patterns can trigger manic episodes o Seasonal patterns are common BP Psychological Factors  Similar to unipolar disorders o Stressful life events o Personality and cognitive variables  Interpersonal processes are very important o Dysfunctional family interactions often linked to onset of manic episodes Cultural Considerations  Prevalence rates of unipolar depression differ across countries o Top three: France, US, Netherlands, NZ o Also, China, Mexico, India, South Africa  Less variability in rates of bipolar disorder o More heritable  Differences in symptom expression o Depression manifests as physical symptoms in Asian and African cultures Treatment of Bipolar Disorder  Medication! The most effective and easily implemented; good stabilizer  Can be dangerous if not prepared properly  Easily to give wrong medication based on wrong diagnosis  ECT: has been shown to help with manic episodes  CBT: Good for helping with depressive symptoms but not as effective for manic episodes Suicidal Behavior (65 +) Adults-more lethal means for suicide (firearms) -Men become more socially isolated when they age **White males: all about social support -Those who have more social support are less at risk for suicide Chapter 8: Personality Disorders Cluster A: Odd/Eccentric Schizoid Personality Disorder -No strong attachment to others, not interested in relationships (not even sexual) -Interpersonal behavior Causal Factors  Only modest heritability  High introversion and low on openness; very okay with engaging in the same behaviors  Hard time identifying others feelings-may respond inappropriately Paranoid Personality Disorder  Causal factors o Biological  Low levels of agreeableness and high levels of neuroticism (high anxiety)  More common in families with schizophrenia o Behavioral  Characteristics of many personality disorders  Parental neglect or abuse o Cognitive Thought: Other people are our to get me Schizotypal Personality Disorder -Peculiar thought patterns-overlap with paranoid personality disorder  Routines with no particular reason that they engage in -Think that others don’t get their thoughts but to them it makes perfect sense -Blunted affect, tangential speech (relevant to them but not tying it in to the conversation effectively) -Odd and eccentric types of behaviors like you would see in schizophrenia Cluster A demographics: More males than females Cluster B: Attention seeking, more advanced interpersonal interactions 1. Histrionic Personality Disorder  Theatrical  Overly concerned with attractiveness  Lots of discomfort if not the center of attention-fear they’re not important and therefore, engage in exaggerated behaviors o Where dramatizing physical appearances come in  More prevalent, but still rare  More females 2. Narcissistic Personality Disorder  Making sure other people know how great they are  Don’t see weaknesses in themselves  May be likely to rise to the top, despite expertise  More males  “I don’t need attention but I want you to recognize how wonderful I am” Causal Factors: Histrionic  The way women socialize could be a precursor for women to develop this disorder  Extraversion and neuroticism  “Unless I entertain people no one will like me”  “People will leave me if I don’t captivate them” Needs to be the life of the party all the time Causal Factors: Narcissistic  Parents influence-pampering and indulging their child  Low on agreeableness, high on openness and neuroticism 3. Antisocial Personality Disorder  One half of psychopathy  Violate social norms and standards-therefore, engage in illegal behaviors o Don’t know the difference between right and wrong  Impulsive-driven by things that make them feel good (substance abuse, sexual) o Do things that people think about doing, but stop  Sensation seeking  History of conduct problems as a child  CAN feel guilt and remorse  Psychopathy: Not all people with antisocial personality disorder have these psychopathy characteristics o Relax more when scary things happen o Two Dimensions  Antisocial  Impulsive-illegal behavior  Not worrying about modifying behavior  Only having people in their life that are useful to them-if not, they’ll move on  Going above and beyond  Glib, charming, person someone wants to be around  Lack of empathy, remorse, and fear  Lying for fun o 80% with psychopathy meet the criteria for antisocial personality disorder o The one disorder that is the BEST predictor of violence in the future  Causal Factors o Genetic and environmental  Either no genetic predisposition and rough childhood or have the gene but great childhood o Family and Socialization  Poor parental supervision-including parental loss  Parent abuse and neglect o Low Fear Hypothesis and Conditioning  Respond less well to punishment  Less susceptible to anxiety and fear o General emotional deficits  Ability to prey on people more easily  Prevalence o LOW o Hard to research psychopathy because a lot go on to become successful and not go to prison o Sociocultural influence 4. Borderline Personality Disorder  Extreme emotions, unpredictable, “I love you I hate you”  Impulsive-difficult for YOU! o May say very threatening things  Unstable relationships  When their mood is fluctuating so much, they can get very angry  They say that they act out due to chronic feelings of boredom  Most commonly personality disorder-but not so much prevalent  More females get diagnosed o Symptoms we talked about are more in relation to females o Not as severe for males  Comorbidity: mood and substance abuse  Causal Factors o Genetics play a significant role o Serotonin levels are low-more impulsive and thrill seeking behavior o Serious and stressful events in childhood or neglect-very common o Vulnerability (diathesis)+ stress Cluster C: Anxious/Fearful 1. Avoidant Personality Disorder  Very sensitive to rejection-very focused on being people pleasers (especially romantic) while putting own needs aside OR becoming very isolated  Shyness  Insecure, worried about everything they say in their relationships-if I make the wrong move people will leave me  Causal Factors o Introverted, high anxiety o Misperceive what other people are putting out for them  Could stay in very abusive relationships 2. Dependent Personality Disorder  Difficulty separating in relationships  Being alone is out of the question, very discomforting  Indecisive, not wanting to upset the other person  Causal factors o Overprotective parents o Strong belief that they can’t do something on their own 3. Obsessive Compulsive Personality Disorder  I need control over my life  Concern with order and rules in their life as well as trivial details  Perfectionist-the kind that wouldn’t be helpful o Picking out odd things to care about  Lack of expressiveness and warmth o Others aren’t doing the same as them and that upsets them  Difficulty in relaxing and having fun  Causal Factors o High on conscientiousness and assertiveness (because something is that important to them) o Low in novelty behaviors, not interested in harming themselves (very careful and methodical in everything they do-regardless if it is reasonable or not)  Prevalence o Low rates o Avoidant and dependent-males and females are equal o OCPD-males outweigh females *Key difference between OCD and OCPD!! Treatment of Personality Disorder  Difficult to treat! o Difficult to diagnose o Disorders are infused into someone’s personality and are how they are and therefore, may not seek treatment o May not want to form a relationship with a therapist  Will only come into treatment most of the time on someone else’s behalf  Personality disorder + Axis 1 disorder-anxiety, mood-what we’ve been talking about in class (may be what’s being targeted)  Cognitive therapies  Medications  Borderline Personality Disorder o Dialectical Behavior Therapy (a form of CBT)  Decrease self-harming behavior and behaviors that interfere with therapy  Missed sessions, want people to be truthful  Decrease behaviors that interfere with a stable lifestyle  Engage in dangerous levels of substance abuse  Increase good interpersonal skills  Increase tolerance for distress Eating Disorders U.S. spends $30 billion on dieting products Eating Disorder: Characterized by a severe disturbance in eating behavior *Very devoted  Anorexia Nervosa: Intense fear of gaining weight and being underweight o DSM-5 Criteria  Have a certain (lack of) body weight  Even though they are underweight, there is still an intense fear of gaining weight  Distorted perception of their body size and shape o Restricting Subtype  Persistent efforts to limit food intake o Binge Eating/Purging Type  Binge: Out of control consumption of food intake (1500 calories in one sitting)  Others do sometimes plan out their binge eating  Feeling ashamed  Eating far more food than what most people would eat in the same amount of time  Purge: Removal of food (not just vomiting) o Other  Excessive exercising or fasting o Diagnosed at a young age (as young as 7-8!) Mainly adolesence  Bulimia Nervosa: Frequent episodes of uncontrollable binge eating followed by inappropriate behavior to prevent weight gain o DSM-5 Criteria  NOT underweight  Binge eating: large amount of food eaten in one sitting with a lack of control  Have to binge or purge at least once a week for 3 months  If one is diagnosed with bulimia and anorexia, they will be diagnosed as anorexia  EXTREME ways to get rid of the food o Early adolescence/late adulthood o Guilt is present  Binge Eating Disorder: Often significantly overweight (although it’s possible to be at a normal weight) o DSM-5 Criteria  Recurrent episodes  3 or more of the following  Eating more rapidly  Eating until they feel uncomfortably full (becomes reinforcing)  Eating even when they’re not hungry  Eating alone because they feel embarrassed eating in front of others (as a result of others who notice their symptoms)  Feeling disgusted, depressed, or guilty afterwards  Purging behavior  Occurs at least once a week for 3 months  Can only be diagnosed with this if they do NOT have bulimia or anorexia o Latest age of onset  Prevalence o Binge eating disorder is most common o More common in women then men, although men are still pretty high  Hard because there are different body types in men v. women o Evidence that more middle aged women are on the rise for eating disorders  Media influences  Men o Symptoms look very similar to females o More likely to have a history of being overweight before their eating disorder occurs o Gay men are more likely to be diagnosed  Lesbians and heterosexual women have an equal risk o Muscle Dysmorphia  Subtype of Body Dysmorphic Disorder in the DSM-5  Engaging in extreme muscle growth  Comorbidity (may overlap with) o *Depression o *OCD o *Substance abuse o Personality disorders o Self harm behaviors  Physical Consequence of Anorexia o Lots of medical problems! o Death-muscle mass becomes so low it affects how the heart works o Kidney damage o Renal failure o Low testosterone levels o Dry skin, brittle hair and nails o More peach fuzz-the body is trying to keep itself warm o Low blood pressure o Vitamin B deficiency o High risk for osteoporosis o Infertility  Physical Consequences of Bulimia o Electrolyte imbalances o Low potassium  Low muscle growth, low blood pressure o Damage to hands, throat, and teeth from induced vomiting  Dentists are usually the one who are the first ones to see symptoms  Course and Outcome of Anorexia o 51% fully recovered o If something is forced upon them and they are not ready for that, they are at a very high risk for suicide o VERY vulnerable o 1 cause is medical complications and the 2 ndis suicide  Family Influences o Parents that are rigid, overprotective, and very controlling  The only thing that they can control is their body  Basically teaching a child what to value  Very important for the parents to MODEL the behavior that want their child to elicit-making it a family point of change  Individual Risk Factors o Thin is the ideal and highly desirable o Perfectionistic-pursue the perfect body o Negative body image-different perceptions about what is fat o Males and females have similar concerns on eating  Sociocultural Factors o Fiji Study  What is the media influence on eating disorders  High rates of women being overweight-in their culture, being overweight is associated with being strong, able to work, and kind  Skinny was looked at as sick and incompetent  American TV shows were shown in Fijidieting increased


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