Abnormal Psych: Exam 3

Paraphilic disorders

Recurrent and intense sexual urges, fantasies, or behaviors that involve: - nonhuman objects - children - adults - or the experience of suffering or humiliation - this diagnosis is applied when the paraphilias cause significant distress or impairment OR when acting on these paraphilias places oneself or others a risk (based on current or past behavior) - the use of "-ic" is used to elevate the language to reflect the severity of this disorder (i.e. it "ups" the stigma) - there is NOT a lot of scientific evidence to support these explanations, but behavioral/cognitive-behavioral explanations are treatments are often used - anti androgens are also used sometimes - these drugs lower testosterone production and reduce sex drive - they may also disrupt normal sex feelings and behavior as well - thus, these drugs are used mostly when disorder is particularly dangerous

1950s form of Institutional Care

- during the 1950's, the introduction of Milieu therapy and Token economies led to more humane and more effective forms of treatment that finally offered hope to chronic patients

Which neurotransmitters are present in abnormal levels in the eating disorder-related circuit

- serotonin - dopamine - glutamate

Family Environment's impact on the emergence of eating disorders

- 1/2 of the families of people with anorexia or bulimia have a long history of emphasizing thinness, physical appearance, and dieting - may be due to an enmeshed family pattern *ENMESHED FAMILY PATTERN: - a family system in which members are over-invovled with each other's affairs and overly concerned about each others welfare - this may allow little room for individuality and/or independence - as a result, the child is subtly forced to take on the "sick role" and develops an ED to do so - the ED enable the family to maintain appearance of harmony because the sick kid needs family and the family can rally to protect him/her - this theory, however, doesn't really show how family patterns set the stage for ED developement

Peak age of onset of binge-eating disorder

- 20s (not during adolescence like the other disorders)

Starvation Study

- 36 normal weight subjects we're put on a semi-starvation diet for 6 months RESULTS: - subjects became preoccupied with food and eating - they planned meals - talked about food more than anything - studied cookbooks and recipes - mixed food in odd combinations - reported vivid dreams about food - once they were allowed to return to normal eating habits, many participated in binging behavior - some also continued to be hungry even after eating large meals

Agranulocytosis

- a life-threatening drop in white blood cells - 1 - 1.5% of those who take Clozaril (clozapine) are at risk of developing this condition - other atypical drugs do not produce this undesired effect - therefore, those who take this drug must be given frequent blood tests so that this condition can be spotted quickly and the drugs stopped

Back wards

- created in response to overcrowding, understaffing, decreased funding and poor patient outcomes - these problems led to the loss of individual and personal care, which in turn resulted in the failure of many patients to improve - the patients who failed to improve were sent to these chronic wards which functioned more like human warehouses filled with hopelessness - some common practices in these wards included straight jackets, handcuffs, and lobotomies (more extreme obviously) - spending time in these wards put patients at risk for developing additional symptoms such as social break down syndrome Social breakdown syndrome: - characterized by extreme withdrawal, anger, physical aggressiveness, and a loss of interest in personal appearance and/or functioning

Mortality rate of anorexia nervosa

- MOST PATIENTS RECOVER - however, ~2-6% will become seriously ill and die as a result of medical complications or suicide **the suicide rate of individuals with anorexia is FIVE TIMES that of the general population

What other psychological problems are commonly experienced by those with anorexia nervosa?

- depression - anxiety - low sense of self-worth - obsessive-compulsive patterns

Anitpsychotic drugs

- emerged in the 1950's - discovered by Henri Laborit, while researching antihistamines for allergies - he found that phenothiazines (group of antihistamines) could be used to help calm patients about to undergo surgery - the most impressive of these was chlorpromazine (Thorazine) - treatment with these drugs is now considered the most effective primary treatment for schizophrenia - Typical (1st generation) and Atypical (2nd generation) drugs both exist

Schizophrenia (the basics)

- a psychotic disorder in which persona, social, and occupational functioning deteriorates as a result of perceptual, emotional, cognitive, and potentially motor abnormalities - 1/2 of those affected will experience significant difficulties with memory and other cognitive functioning as well - affects ~1 in 100 people in the world (1% prevalence) - usually NOT considered to be induced by substance abuse (more organic) - this disorder is found among ALL socioeconomic groups although it occurs more frequently in the lower levels (downward drift theory) - the symptoms, triggers, and course of schizophrenia vary greatly - this disorder includes a wide range of symptoms that are grouped into positive, negative, or psychomotor symptoms - individuals have a shorter life expectancy and pose a heavy burden on their families - this disorder is diagnosed EQUALLY among men and women - age of onset for men = early 20s (~23yrs) - age of onset for women = late 20s (~28) - sufferers experience 3 phases (prodromal, active, and residual), each of which may last for days or years - 25% fully recover **Type 1 = more positive than negative symptoms - more easily treated and more significantly affected by medications - meds alleviate (+) symptoms more easily - individuals identified with this variation often better adjust pre-morbid, have a later onset of symptoms, and are more likely to show improvement (esp. with meds) **Type 2 = more negative than positive symptoms

Bulimia Nervosa

- a.k.a. binge-purge syndrome - characterized by both binging and purging/compensatory behaviors WITHOUT having a significantly low body weight - weight usually stays within the normal range (not over or under weight) but may fluctuate significantly within that range - if they become under weight, diagnosis shifts to binge-purge type anorexia - weight usually stays within the normal range but may fluctuate significantly within that range - often lasts for years with periodic let up Binging: - bouts of extreme overeating during a limited period of time (usually ~2hrs.) - on average, individuals consume 2,000-3,400cal per binge (up to 10,000) - these binges occur 1-30 times a week but they MUST binge at least 1 time a week for 3months to be diagnosed (this is minimum severity; any more than once a week constitutes a more severe condition) - they eat massive amounts very rapidly with minimal chewing - usually go to sweet, high cal. foods with soft textures (ice cream, cookies, doughnuts, sandwiches, etc.) - they hardly taste or even think about what they're eating - usually carried out in secret - usually preceded by feelings of tension - they feel irritable, "unreal," and powerless to control their overwhelming need to eat "forbidden" foods; they feel like they can't stop - they experience pleasure followed by feelings of self-blame, shame, guilt, depression, fear of gaining weight, and/or fear of being discovered - most individuals KNOW that they have a disorder Compensatory Behaviors: - used as an attempt to "undo" the effects of their binge - behaviors include vomiting; the use of laxatives, diuretics, and enemas; fasting; excessive exercise; etc. - vomiting fails to prevent the absorption of 1/2 of the calories consumed during the binge - laxatives and diuretics also fail to undo the caloric effects - these behaviors temporarily relieve physical feelings of fullness - temporarily reduce feelings of anxiety and self disgust that are attached to bingeing - overtime, a cycle develops in which during allows more bingeing, which then necessitates more purging, which eventually leads people to feel powerless and disgusting - additionally, repeated vomiting often affects the ability to feel satiated, which leads to greater hunger and bingeing **symptoms may last for several years with periodic letup or remission of these symptoms (wax and wane pattern) **periods of no symptoms or remission that last for longer than 1 year are associated with better long-term outcomes

Typical Antipsychotics

- a.k.a. conventional antipsychotics - developed from 1960s-1980s - address POSITIVE symptoms - they appear to affect the extrapyramidal areas of the brain, which help control motor function (striatum) - they primarily target D-2 receptors in an effort to block/decrease dopamine activity - HOWEVER, these are often known as "dirty drugs" because their specificity isn't great, and they increase the probability that the patient will experience neurological (esp. motor related) side effects - sometimes called neuroleptic drugs because they often produce undesired movement effects - such side effects are so substantial that they are listed in the DSM-5 as their own separate disorder - most common of the effects produced PARKINSONIAN symptoms (due to dopamine levels being way too low), which include muscles tremors and rigidity, bizarre movement of the face, neck, tongue, and back, great restlessness (akathisia), agitation and discomfort in limbs, etc. - patients may also develop TARDIVE DYSKINESIA if these drugs are taken for an extended period of time

Characteristics of the INSULA in the eating disorder-related brain circuit

- abnormally large and active - this structure also function in the anxiety related structure

Gender dysphoria

- adds the experience of significant distress and impairment to being transgender (transgendered folks who experience unhappiness and distress/dysfunction) - this was previously called "gender identity disorder" - many argue that gender dysphoria is, in fact, a medical problem that may produce personal unhappiness while others believe that transgendered-ness reflects an alternative and not pathological experience of gender identity so should not be considered a mental health disorder even in the presence of extreme unhappiness (this is becoming the dominant perspective) - while most transgendered folks experience at least some distress, surveys suggest that the primary cause for intense dysphoric responses is the enormous prejudice that trans people typically face (80-90% have been harassed; 50% have been fired, not hired, or not promoted; and 20% have been denied a place to live) - HOWEVER, when supported by friends and family, these people don't typically experience significant mental health problems

Medical complications of anorexia nervosa

- amenorrhea - low body temp. - poor circulation - lanugo - slow heart rate arrhythmias - metabolic and electrolyte imbalances (can lead to date by heart failure or circulatory collapse) - lowered testosterone levels - body swelling - decreased bone mineral density - poor nutrition also leads to rough, dry, or cracked skin; cold and blue hands/feet; loss of hair from scalp; and lanugo on trunk, extremities, and face **many grapple with substance abuse and display OCD patterns **such patterns include cutting food into shapes, following rigid rules for food prep, and participating in compulsive exercise **many are also "perfectionists" but this usually precedes the onset of the disorder

Masochism

- arousal by being humiliated, beaten, bound, or otherwise made to suffer - believed to be learned through classical conditioning - some practice hypoxyphilia, which is the act of strangling or smothering themselves for pleasure autoerotic asphyxia = when males (usually ~10yrs. old) will hang, suffocate, or strangle themselves by masturbating

Diagnostic Criteria for Schizophrenia

- at least 2 symptoms must be present during a 1 month period - one of those symptoms must be positive - symptoms must persist for 6 months or longer - individuals must also show a deterioration in their work, social relations, and ability to care for themselves (hygiene) - can specify first or multiple episodes - can exist with or without catatonia (unresponsiveness)

Token Economies

- based on OPERANT conditioning with focus on changing behaviors - positive reinforcement was the most common form used - patients were rewarded when they behaved in socially acceptable ways, and were not rewarded for unacceptable behavior - examples of rewarded behaviors included personal hygiene, participating in a work program, speaking appropriately, etc. - the rewards were tokens that patients could exchange for food, cigarettes, certain privileges, etc. (all tangible) - research has shown that this form of treatment does help to reduce schizophrenia-related behavior, improve self-image, and improve personal care (is universally applicable) HOWEVER, this treatment does have several limitations: - many token economy studies are uncontrolled - in other words, such studies do not use a control group, so patients' improvements can ONLY be compared to their own past behaviors - this can be misleading because it does not control for other factors that may impact the patients' behaviors (environment, physical setting, etc. - these studies have also not proven to be very effective - although the over behavior is changed, these studies do not address the underlying psychotic thoughts or perceptions that may play a role in schizophrenic behaviors - they only target surface level behaviors - additionally, many patients have a very difficult time transition from token economies to community living - when the real world doesn't reward them, they abandon the behaviors they acquired in treatment, resulting in relapse - there is also the question of ethics - if token economies are going to be successful, administrators need to control the important rewards in a patients life, which may include basic ones like food or a comfortable bed - BUT there are certain things that we as humans are entitled to, so ethically, there are things that can no longer be controlled in order to preserve the basic rights of the patients - such things include food, furniture, freedom of movement, and/or space (storage space)

Miliue therapy

- based on humanistic principles (Maslow and Rogers; unconditional positive regard; hierarchy of needs; self-actualization) - theorists proposed that institutionalized patients deteriorate because they are deprived of opportunities to exercised independence, responsibility, and positive self-regard as well as opportunities to engage in meaningful activities - therefore, this treatment focused on providing a social environment (milieu) that promotes productive, meaningful activities, which in turn promote responsibility and self-respect - such activities gave patients something to do and a sense of purpose - pioneered by Maxwell Jones, who turned back wards into therapeutic communities and began referring to patients as "residents" - this therapy encouraged interactions between patient and staff and encouraged patients to keep active and raise their expectations about what they can accomplish - clear rules were also set up with very clear consequences as a way to instill a sense of responsibility This treatment had moderate success: - those who received this form of treatment began leaving hospitals at higher rates and often improved significantly - resident self governments and work schedules as proved to be effective - however, many remained impaired and still had to live in a sheltered setting after their release (only moderate improvement)

What % of women in western countries will develop anorexia nervosa

- between 0.6 and 4.0% - MANY more will display symptoms

Similarities in BOTH anorexia nervosa and bulimia nervosa

- both begin with intense dieting by those who fear weight gain - people in both categories are driven by their desire to be thin - both are preoccupied with food, weight, and appearance - both are struggling with depression, anxiety, obsessiveness, and a need to be perfect - both experience a weighted risk of suicide attempts and fatalities - substance abuse (which often starts with an excessive use of diet pills) may accompany either disorder - both believe they weigh too much and look too heavy regardless of reality - both are marked by disturbed attitudes toward eating **most powerful contributor to dieting and to the development of eating disorders = BODY DISSATISFACTION

Binge-Eating disorder

- brand new to the DSM-5 (identified 60yrs. ago in 1959) - symptoms include a pattern of binge eating with distress and NO compensatory behaviors (i.e. bingeing without purging) - 2/3 of these individuals will become overweight/obese even though compensatory behaviors really aren't very effective - HOWEVER, most overweight people do NOT binge (their weight results form frequent overeating along with other bio, psycho, sociocultural factors - the binges of this disorder are characterized by the same features and cognitive patterns as though experienced in bulimia nervosa - unlike the other 2 disorders, this one does NOT begin with extreme dieting and individuals are NOT as driven to thinner as those with bulimia and anorexia

Atypical antipsychotics

- developed after 1980's - most common = Clozaril (most effective; a.k.a. clozapine), Resperidal, and Abilify - these new drugs tend to be MORE EFFECTIVE - they target fewer dopamine (D-2) receptors along with more serotonin receptors (D-1 and D-4) - they can treat positive AND negative symptoms - they cause fewer extrapyramidal side effects and seem less likely to cause tar dive dyskinesia - they do, HOWEVER, carry a risk of agranulocytosis, which is a life-threatening drop in white blood cells - other side effects may include weight gain, dizziness, metabolic problems, sexual dysfunction, cardiovascular changes, and significant elevations in blood sugar - 1/2 of all those who are medicated for schizophrenia are prescribed this kind of drug **antipsychotics reduce symptoms in ~70% of patients - thus, drug therapy appears to be more effective than any other approach on its own - maximimum levels of improvement often occur within the first 6months of treatment - BUT med compliance is difficult, and symptoms may return if meds are stopped too soon - when changed to a placebo after 5yrs., 75% relapsed within a year as compared to the 33% who relapsed even while continuing to take their meds

Alexithymic

- people who have great difficulty putting descriptive labels on their feelings

Treatment of Schizophrenia: Psychotherapy

- can be very helpful when used in combination with drug therapy Cognitive-behavioral - most research supported psychotherapy in the treatment of schizophrenia - it seeks to change how individuals view and react to their hallucinatory experiences - provides education and evidence of biological causes - helps them to identify patterns of their hallucinations and delusion - helps them learn more accurate interpretations - teaches them techniques for coping - includes cognitive remediation and hallucination reinterpretation and acceptance - COGNITIVE REMEDIATION focuses on cognitive impairments like difficulties in attention, planning, and memory; improvements in these areas tend to the client's everyday life and social relationships - HALLUCINATION REINTERPRETATION and acceptance is designed to help change how people view and react to their hallucinations (zombie example) - these cog.-behavioral techniques help people feel some control over their hallucinations and reduce their delusional ideas - these DON'T eliminate hallucinations but they do make them less powerful and less destructive - re-hospitalization decreases by 50% with this kind of treatment Family therapy - over 50% of those recovering from schizophrenia and other severe disorders live with their family members - this creates significant family stress along with high expressed emotion - those who feel positive towards their family do better in treatment - therefore, therapy address these difficulties and provides education - family support groups are also offered

What causes eating disorders: Biological Factors

- certain genes may leave some people more susceptible to E.D.s - realties of people with E.D.s are up to 6 times more likely to develop the disorder themselves - supported by twin studies (70% likelihood that an identical twin will develop ANOREXIA if other twin has it and a 20% liklihood for fraternal twins; 23% for identical twins and 7% in fraternal twins with BULIMIA) - other theorists believe that E.D.s may be related to dysfunction of the brain circuitry (esp. in the lateral and ventromedial hypothalamus) - such dysfunctions include: - abnormal communication/interconnectivity problems - abnormal anatomy or operation of individual structures in circuit - abnormal levels of activity by neurotransmitters - this circuit is the same as the one associated with generalized anxiety disorder, OCD, and depression

Negative symptoms of Schizophrenia

- characteristics that are LACKING in typical thought emotion or behaviors - they are deficits that indicate pathology These symptoms include: - poverty of speech - blunted and flat affect - loss of volition - social withdrawal

Transvestic Disorder

- characterized by fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex in order to achieve sexual arousal - also known as cross dressing - must include distress and/or impairment - typical person with this disorder is a HETEROSEXUAL MALE, who began cross-dressing in childhood or adolescence Causes: - cognitive-behavioral = learned through classical conditioning - very little research support **cross-dressing = main characteristic

What causes eating disorders: Psychological approach (Cognitive-Behavioral with an emphasis on Cognitive)

- cognitive-behavioral theorists state that a broad cognitive distortion is at the core of eating disorders - this "core pathology" contributes to all other aspects of the eating disorders, including repeated efforts to lose weight and the preoccupation with shape, weight, and eating - the inability to control shape and weight results in significant maladaptive thought problems ("I'm worthless; "I'm gonna get fat"; etc.) - individuals judge themselves based on their shape, their weight, and there ability to control them - there's really no research support for cognitive deficients by the cause of E.D.s but many cognitive-behavioral theorists work on this assumption and center treatment around correcting the clients' cog. distortions and accompanying behaviors (cog.-behavioral therapy is the most widely used treatment) - many people with eating disorders (esp. bulimia) experiences symptoms of depression - this is supported by four kinds of evidence: 1. many more people with an E.D. qualify for major depressive disorder than do people in the general population 2. close relatives of people with E.D.s seem to have higher rates of depressive disorders than do realties of people without an E.D. 3. the depression-related brain circuit of many people with E.D.s shows abnormalities that are similar to those with depression 4. People with E.D.s are often helped by the same antidepressant that decrease symptoms of depression **essentially, this theory suggests that depression causes E.D.s

Cognitive-Behavioral therapies for treatment of anorexia nervosa

- cognitive-behavioral therapy is designed to help clients appreciate and alter the behaviors and though processes that allow their restrictive eating to continue Behavioral techniques: - in the beginning when the main goal is to return to a healthy weight, behavioral therapists will deny intravenous feeding (which creates client-therapist distrust) and instead use weight-restoration approaches - these approaches offer rewards when patients eat properly or gain weight and they give NO reward when they eat improperly or fail to gain weight (operant conditioning) - additionally, therapists will also encourage self-monitoring of feelings, thoughts, hunger levels, and food intake (keeping a diary) - this helps clients understand their own patterns, which they may not have otherwise been able to identify Cognitive techniques: - therapists teach clients to identify and correct their distorted thinking patterns and maladaptive attitudes toward eating and weight - they challenge clients to identify that "core pathology," which is the deep seeded belief that they should be judged by their shape/weight and by their ability to control these physical characteristics - they encourage them to recognize their need for independence and then teach them more appropriate way to exercise control - they provide education about thinking patterns and body distortions as well as alternative ways of coping with stress - cognitive therapists may also teach clients to better identify and trust their INTERNAL SENSATIONS AND FEELINGS - they educate them about the body distortions that accompany anorexia and help them to see that their own assessments of the size are incorrect - clients may never be able to judge their body accurately, but after treatment, they may be able to acknowledge their own misperceptions **this treatment is very effective (more so than psychodynamic treatment, psychoeducation, or supportive therapy alone)

Downward drift theory

- folks in higher socioeconomic statuses are just as susceptible to schizophrenia and may drift down to a lower socioeconomic status with the onset of this disorder and as it worsens

Treatment for Gender dysphoria

- goal is to address incongruence between gender identity and physical character (often using biological intervention) - treatment includes hormone administration and gender reassignment surgery (gender change/confirmation/affirmation/etc.) - this surgery is usually preceded by 1-2yrs. of hormone treatment - treatment has a 70% satisfaction rate - gender reassigned individuals often have a greater reis of psychological disorders and suicide attempts as compared to the general population (pre-treatment psych disorders of result in the individual regretting the surgery)

Fetishistic Disorder

- hard to pinpoint cause - recurrent and intense sexual urges, fantasies, or behaviors that involve the use of a nonliving object or non-genital part (often to the exclusion of all other stimuli) - this object MUST be present for arousal - more common in MEN - usually begins in adolescence - almost anything can be a fetish - most common are women's underwear, shoes, and boots

Characteristics of the STRIATUM in the eating disorder-related brain circuit

- hyperactive - also functions in the OCD-related circuit

Treatments for Anorexia Nervosa

- immediate aims of treatment are to regain lost weight, recover from malnourishment, and to eat normally again - such goals usually involve NUTRITIONAL REHAB, which uses various methods to help patients gain weight quickly and return to health (usually takes ~8-12weeks to accomplish) - the most popular weight restoration technique is a combination of nursing care, nutritional counseling, and a high calorie diet (more than 3,000cal per day) - in the past, this treatment was administered in a hospital setting, but now it is often offered in day hospitals or outpatient settings - treatment may also focus on the underlying psychological problems in order to achieve lasting improvement (2nd aim of treatment = address psychological and situational factors) - 1/3 of those with anorexia will receive treatment - treatment emphasizes cognitive-behavioral therapy, which is often used in combination with individual, group, and family approaches along with psychotropic drugs (in some cases) **Treatment includes Cognitive-Behavioral therapies and psychotropic drug therapy

1963 Community Mental Health Act

- implemented deinstitutionalization and aimed to eliminate the "revolving door" effect (endless cycle of stabilization and relapse that occurred without community support) - provided effective community care, which included meds, psychotherapy, help in handling daily stress and responsibilities, decision-making guidance, social skills training, residential supervision, and vocational training Five Key Features: 1. Coordinated services - introduction of Community Mental Health centers provided a "one-stop-shop" for those suffering from mental health disorders - 1 building/1 location, where an individual can get medical attention of all kinds (meds, psychotherapy, etc.) 2. Short-term hospitalization - first try to treat with outpatient services with a combination of meds and psychotherapy - if this fails, they may be hospitalized for only a few weeks (as opposed to months or years) and are then released for "aftercare"/follow-up care in the community 3. Partial hospitalization - introduced day programs (8am-5pm) in which patients get to return to their homes for the night - has become associated with fewer relapses 4. Supervised Residences - "halfway houses" for those who don't need to be hospitalized but can't live alone or with their families - shelter 1 - 24 people - staffed by paraprofessionals who receive training and guidance from mental health professionals - run according to milieu therapy 5. Occupational training and support - included sheltered workshops (supervised workplace for those not ready for real/competitive jobs) - provides paid employment so patients can start generating their own income along with independence, self-respect, and the stimulation of working with others - not consistently available tho

Multicultural factors that may cause eating disorders (sociocultural perspective)

- in the early 1990's, African Americans (AA) were significantly healthier than white Americans - AAs exhibited much more positive eating behaviors and attitudes - only 70% were dissatisfied with their body as opposed to 90% of the white community - this could be due in part to the differing beauty ideals across these two cultures - AAs place more emphasis on personality than outward appearance, which white people are obsessed with - thus, AAs were less likely to diet for extended periods NOW: - 65% of AAs report dieting - 39% say food controls their life - 19% avoid eating when hungry - 17% use laxatives - 4% vomit to lose weight **this shift may be due to acculturation, which is the social, psychological, and cultural change that stems from the bleeding of cultures EX: - AAs at a mostly white college had higher depression scores than AAs who did not attend such schools

Sadism

- individual (usually male) is repeatedly and intensely sexually aroused by the physical or psychological suffering of another individual - named after Marque de Sade, who tortured others to satisfy his sexual desires - likely performed as an attempt to exhibit power or control

Active phase

- phase of schizophrenia where diagnosis is made - symptoms become more intense - being in this phase is often referred to as an "episode"

Transgender

- individuals who have a strong sense that their gender identity is different from their birth anatomy - these individuals make up ~0.8% of the world's adult population - individuals may want t acquire primary or secondary sex characteristics of an alternate sex, and often seek treatment - many people believe that the transgender experience reflects alternative (not pathological) ways of experiencing one's gender identity - therefore, they believe that it should NOT be considered a mental health disorder, even if associated with extreme unhappiness - transgender women outnumber trans men 2:1 - transgender feelings may occur in children BUT these feelings often disappear in adolescence and many such children do not become trans adults (1.5% of young boys wish they were girls and 3.5% of young girls wish they were boys) - as a result, irreversible physical procedures are not recommended until child reaches 14-16yrs. of age - 90% of trans people experience moderate distress and dysfunction and often face significant prejudice - for some, this distress takes the form of sever anxiety, depression, substance use, and thoughts of suicide *transexual implies full gender change *1st country to rule that transgender individuals are no longer considered mentally ill in tis health system = Denmark (2017)

Institutional Care

- individuals with schizophrenia were institutionalized in public mental hospitals in which the primary goals were restrain and to meet basic human needs - patients were often considered "beyond help"

Binge-eating/purging type

- individuals with this subtype may engage in eating binges - BUT unlike those with bulimia nervosa, these individuals LOSE WEIGHT by purging - they force themselves to vomit after meals or by abusing laxatives/dieuretics **main difference between this disorder and bulimia nervosa is that those with those with this disorder will present at a SIGNIFICANTLY LOW BODY WEIGHT, whereas those with bulimia will NOT

Restricting Type Anorexia Nervosa

- lose weight by restricting food intake (i.e. dieting or fasting) - individuals show almost no variability in their diet - they usually cut out sweet and fattening foods first until they eventually eat next to nothing

Gender differences and eating disorders

- males account for ONLY 10% of all cases of EDs - this number may be lower than what is true - this low value could be due to a double standard of attractiveness - also could be explained by the fact that men are less likely to report or seek treatment for the feelings and behaviors attributed with EDs, because EDs are considered a stereotypically female difficulty (don't want to be ridiculed or emasculated) - males favor different methods of weightless; where women usually are more likely to use dieting, men are more likely to use exercise to lose weight - because dieting usually precedes an ED, it makes sense that EDs are more prevalent in women - 37% of men with an ED had jobs/played sports for which weight control was important (compared to 13% of women) - some such sports that generated the highest risk for EDs were jockeys, wrestlers, distance runners, bodybuilders, and swimmers - fun fact: jockeys can shed up to 7lbs just hours before a race using a sauna, laxatives, forced vomiting, diuretics, etc. - body image is still the key factor in the development of EDs in men - men, however, often experience slightly varied versions of the EDs we've discussed - many experience REVERSE anorexia nervosa (muscle dysmorphia) - with this disorder, men see themselves as scrawny and small and use extreme measures (power lifting, steroids, etc.) to get the "perfect body" - 1/3 of those with this disorder also engage in related dysfunctional behavior (binge eating) **this disorder is NOT currently in the DSM

Biological explanation for Transgender/Gender dysphoria

- many clinicians suspect a biological basis for these conditions (i.e. they stem from genetic or prenatal factors) - others site differences in brain anatomy and functioning - it has been observed that the brains of trans men have thing subcortical areas, much like the brains of traditional men - this supports the theory that the brains of trans people are more similar to the brains of the gender that they identify with than the brains of the gender they were assigned at birth - other research has found similarities between trans people and their non-trans counterparts with regard to activity in the insulation, anterior cingulate cortex, and bed nucleus consciousness (BST), which all play a role in gender functioning and consciousness - aligns with the "male brain trapped in a female body" idea - others argue that its a unique brain altogether (a "trans-brain")

What causes eating disorders: Sociocultural approach

- many theorists believe that current Western standard of female attractiveness are partly responsible for the emergence of E.D.s - society's preoccupation with dieting and thinness has become pervasive over the past 60yrs. (showing up everywhere and increasing across ALL races and socioeconomic statuses) - some subcultures have an esp. high risk of developing an ED (models, actors, dancers, athletes, etc.) - EDs can also be tied to social networking, internet activities, and television browsing (esp. in adolescent girls) - W. society glorifies thinness and holds prejudice against overweight people - for example, chubby kids are often perceived as less friendly, energetic, intelligent and desirable - in one study, preschool kids chose a thin doll over a chubbier one but were unable to explain why (shows the unconscious influence of society) **the sociocultural perspective can be subdivided into the influence of the family environment, multicultural factors, and gender differences

Residual phase

- more (-) symptoms reported than (+) ones - return to prodromal-like intensity of symptoms (i.e. more mild) - this disorder is more episodic so these phases can occur for varying lengths of time (days to years)

Body dissatisfaction

- most powerful contributor to dieting and to the development of eating disorders - occurs when people evaluate their weight and body shape negatively - experienced by 73% of girls/women - experienced by 56% of boys/men - girls usually think they're overweight while 1/2 of boys think they're overweight and the other 1/2 thinks they're underweight - men and women are dissatisfied mostly with their stomachs, followed by their weight and finally their hips/thighs - usually results from perfectionism and unrealistic expectations - correlates with unfavorable peer comparisons, low self-esteem, negative parental attitudes about weight, and unfavorable media comparisons - an increase in body dissatisfaction leads to an increase in eating disorders, depressive disorders, anxiety disorders , body dysmorphia, problems in interpersonal relationships, and difficulties at work - 97% of women have AT LEAST ONE negative thought about their body PER DAY! (avg. # of these thoughts = 13) - more time on social media has been linked to increased body dissatisfaction

Glucagon-like peptide-1 (GLP-1)

- natural appetite sukppressant - when injected into rats who hadn't eaten in 24hrs., this chemical caused the rats to reduce their food intake almost entirely even though they hadn't eaten in so long - when "full" rats were injected with a substance that blocks the reception of GLP-1 in the hypothalamus, the rats more than doubled their food intake, even though they were already full

Loss of volition (motivation of directedness)

- negative symptom of schizophrenia - individuals report feeling drained of energy and interest - a.k.a. apathy or avolition - includes an inability to start or follow through on a course of action - those affected have conflicted feelings (ambivalence) about most things

Blunted and flat affect

- negative symptom of schizophrenia - individuals show little emotional expression

Poverty of speech

- negative symptom of schizophrenia - this is a reduction in the quantity of speech, speech content, or meaning - may result in the production of "word salad" in which speech is organized into clusters of words that are difficult to understand - a.k.a. alogia EX: - "My illness is too great to be cured quickly. I am incurable. Everyone who reads these lines will suffer - they will understand my feelings...Everyone will feel and understand. I am a man, not a beast. I love everyone, I have faults..."

Social withdrawal

- negative symptom of schizophrenia - those affected may withdraw from social environment and attend only to their own ideas and fantasies - this seems to lead to a breakdown of social skills - individuals only deal with their own emotions and behaviors

Failure of the Community Approach

- not all those who need services are able to receive them due to: 1. Poor coordination of services - mental health agencies in a community often fail to communicate with one another - to combat this problem, a growing number of community therapist have become case manager to provide assistance in coordinating 2. Shortage of services/funds - shortage of programs available and adequate resources As a result: - many patients return to their families, alternative institutions or even prison without adequate treatment *1/3 of homeless people have a severe mental illness but will not be treated **Despite these shortcomings, community treatment has shown great potential - the National Alliance on Mental Illness (NAMI) pushes for better community treatment and refers to sufferers as "consumers" - they push for more emphasis placed on coordinate of treatment all around the world

Tardive Dyskinesia

- occurs in 15% of those taking TYPICAL antipsychotics for an extended period of time - risk is 3-5% higher for patients over the age of 50 - includes involuntary writing or tic-like movements usually of the mouth, lips, tongue, legs, or body - caused by medication-induced reductions in dopamine activity - to develop this disorder, patients must be taking the drugs for an extended period (doesn't occur right away) - most cases are mild and involve a SINGLE symptoms - the longer the drugs are taken, the higher the risk of developing this disorder - if symptoms are spotted early, meds are stopped and symptoms usually disappear (90% of the time) - however, this condition can be permanent when spotted lated and meds aren't stopped soon enough - 40% of individuals experience permanent symptoms

Delusions

- positive symptom of schizophrenia - faulty although firmly held beliefs or interpretations - includes delusions of persecution, reference, grandeur, or control Persecution: - most common type of delusion - individuals believe that they are being plotted against - specifically they think that harm is or is going to occur at the hands of those plotting against them EX: - "They are spying on me....I can see them. They want to ruin my life because I know their secrets!" Reference: - A neutral event is believed to have a special and personal meaning EX: - "The Bravo channel is sending me cryptic messages that I need to apply for my own reality show" Control: - Belief that one's thoughts or actions are being controlled by outside forces EX: - "The man who lives above me is guiding my thoughts" Grandeur: - Belief that one is a famous or important figure, such as Jesus Christ or Napolean - may also involve the belief that one has unusual powers that no one else has EX: - "I am special. God has appointed me the greatest inventor of mankind"

Hallucinations

- positive symptom of schizophrenia - sensory perceptions that occur in the absence of external stimuli - most common are AUDITORY hallucination, but these perceptions can involve any of the other senses as well (tactile, somatic, visual, gustatory, or olfactory) **PET scans have shown an increase in blood flow to Broca's area during auditory hallucination

Disordered thinking and speech/formal thought disorders

- positive symptom of schizophrenia - may be present long before full on schizophrenia unfold - they cause a great deal of confusion and extreme difficulties in communication - they are oddities in speech that show an excess of what others experience Loose associations: - a.k.a. derailment - most common of the formal thought disorders - a series of ideas are presented with loosely apparent or completely inapparent logical connections - the frame of reference often changes from one sentence to the next. EX: - "He went to the ballpark and bought Frank's beer belly home in a bag of grass seed." - "I think someone's infiltrated my copies of the cases. We've got to case the joint. I don't believe in joints, but they do hold your body together." Neologisms - making up words and then putting them into a context that makes it seem like an actual word EX: - "The only problem I have is my frustionating!" Perseverations: - contextually inappropriate and unintentional repetition in speech that reflects thinking - individuals are often stuck on the same thing over and over again EX: - "It's great to be here in Nevada, Nevada, Nevada, Nevada, Nevada." - "Is your name Mary?" "Yes." "Are you in the hospital?" "Yes." "Are you a table?" "Yes." (giving the same answer to a wide variety of questions) Clang: - the presentation of a long string of ideas, whereby such ideas are related only by similar or rhyming sounds rather than actual meaning EX: - "I heard the bell. Well, hell, then I fell."

Cognitive dissonance theory

- principle behind the prevention of eating disorders - example of a social psych theory - argues that when people adopt new attitudes in treatment (i.e. anti-thinness) that contradict their own attitudes and behaviors from prior to treatment (pro-thinness, pro-weight loss, etc.), they will experience emotional discomfort - this emotional discomfort creates a state of dissonance that they implicitly seek to eliminate by changing their old attitudes and behaviors (i.e. they will alter their old attitudes to match the new ones in order to eliminate the emotional discomfort, leading to healthier cognition)

Limitations of Anorexia Nervosa Treatments

- recovery is NOT always permanent - as many as 25% will continue to have difficulties - 1/3 of those treated will experience reoccurrence (often triggered by stress) - even years later, some are still concerned with weight and appearance, restored diets, anxiety when eating with others, or hold distorted ideas about food, eating, and weight - 1/2 of those treated continue to experience psychological problems such as depression, OCD, and social anxiety - this is most common in those who never reached a fully normal weight by the end of their treatment **often times the more weight a person lost and the longer its been since they entered treatment, the lower their rate of recovery will be **troubled relationships will also decrease the likelihood of positive treatment outcomes - young sufferers often have better recovery rats than older patients (more resilient)

Limitations of Bulimia nervosa treatment

- relapse can be a significant problem, even among those who respond successfully to treatment - relapse is often triggered by stress - 28% of those treated, relapse within 6months of recovery - relapse is more likely when bulimia is more intense **Risk of relapse will increase when the client: - has a longer history - vomits at a high frequency - has a history of substance abuse - progresses slowly at the beginning of treatment - continues to be lonely and distrustful after treatment

What causes eating disorders: Psychodynamic approach

- relies on the idea of ego deficiencies - argues that disturbed mother-child interaction can lead to ego deficiencies in the child - these ego deficiencies may include a poor sense of indolence and control as well as severe perceptual disturbances that jointly help produce disordered eating Bruch's theory: - effective pattens will attend to the biological AND emotional needs of their children while ineffective parents fail to attend to both of these needs - for example, ineffective pattens may decide that the child is hungry or cold or tired without correctly interpreting the actual condition - they feed children when they're actually anxious rather than hungry - as a result, children grow up confused and unaware of their own internal needs (can't separate emotion from physical need) - these children turn to external guides (parents) to identify their feelings, who are obviously unreliable - these children appear to be "model children," but they fail to develop genuine self-reliance and they fail to "experience themselves as not being in control of their behavior, needs, and impulses, as not owning their bodies" - they feel like the can't establish independence (feel helpless) - therefore, as an attempt to overcome such feelings, they seek excessive control over body size, body shape, and their eating habits **only a little clinical and research support (EX: when parents speak for their children; many children mistakenly identify their own anxiety as hunger)

Voyeuristic Disorder

- repeated and intense sexual urges to observe unsuspecting/non-consenting people as they undress or engage in sexual activity - the person may masturbate during the act of observing or while remembering it later - the risk of discovery often adds to the excitement - begins after the age of 15 and tends to persist through adulthood - don't actually want to have sex with the person they're observing - marked by repeated invasion of other people's privacy - some can't have normal sex lives Causes: - many psychodynamic theorist propose that voyeurs are seeking power by their actions because they feel inadequate or are sexually/socially shy - Cognitive-behaviorists explain this disorder as a learned behavior that can be traced to a chance and secret observation of a sexually arousing scene

Pedophilic Disorder

- repeated and intense sexual urges, fantasies, or behaviors involving sexual activity with a child, usually 13yrs old or younger - some people are satisfied with child pornography - others are driven to watching, fondling, or engaging in sexual intercourse with children - evidence suggest that 2/3 of survivors are women - people with this disorder typically develop it in adolescence - most are immature and have underdeveloped social/sexual skills (normal sex relationships make them anxious and sexual difficulties have led them to seek an area in which they can be "masters) , display distorted thinking ("I'm teaching them"; "they wanted it"; "they like it"; etc.), were abused or neglected themselves, and have an additional psychological disorder - some know its wrong while others think its acceptable or normal - some even join pedophile organizations to abolish age-of-consent laws - most are imprisoned or forced into treatment due to legal repercussions Causes: - may be related to irregular activity in amygdala or frontal areas of the brain, but there's really no consistent research support for this Treatment: - aversion therapy - masturbatory satiation - antiandrogen drugs - treatment focuses on relapse-prevention training (cog.-behavioral), which is modeled after programs used for substance use disorders - in this training, clients identify the kinds of situations that typically trigger their pedophilic fantasies and actions (such as depressed mood or distorted thinking) - then they learn strategies for avoiding those situations or they learn to cope with them more appropriately and effectively - this has not proved to be consistency helpful or effective

Exhibitionist Disorder

- repeated, sexually arousing urges or fantasies about exposing their genitals to an unsuspecting individual - a.k.a. "flashing" - its repeated in relatively frequent and intense patterns - 1/3 to 1/2 of all women have reported seeing an exhibitionist - usually beings before age 18 - most common in MALES - those affected are usually attracted to the "shock and awe" of their behavior - they don't really want to engage in sexual behavior with the person they are flashing - studies suggest that those affected are immature in their dealings with the opposite sex and have difficulty in interpersonal relationships - 30% are married - 30% are divorced or separated - causes may be tied to the sex with their wife being unsatisfactory, a doubt in their masculinity, or a strong bond to a possessive mother Treatment: - aversion therapy - masturbatory satiation - may be combined with social skills training or cognitive-behavioral therapy

Causes of Fetishistic disorder

- research is generally unable to pinpoint causes but there are a few theories Psychodynamic perspective: - view fetishes as defense mechanisms that help people avoid the anxiety produced by normal sexual contact - treatment has little success Cognitive-Behavioral perspective: - proposes that fetishes are acquired through CLASSICAL conditioning - treatments include aversion therapy, covert sensitization/imaginal exposure, and masturbatory satiation Aversion therapy: - shock is administered when subject imagines their fetish - after 2 weeks, subjects showed at least some improvements Covert sensitization/Imaginal exposure: - therapist guide the subject to imagine the fetish and then guides them to imagine an aversive stimulus until the fetish is no longer desired - basically aversion therapy done imaginally Masturbatory satiation: - client masturbates to orgasm while thinking about something that is sexually appropriate (picture of a naked woman) - then they switch to think about the fetish while continuing to masturbate to the point of bored, which then becomes linked to the fetish

Causes of Schizophrenia: Sociocultural

- sociocultural theorist believe that 3 main social forces contribute to schizophrenia: multicultural factors, social labeling, and family dysfunction - research has not yet cleared what their precise causal relationship might be Multicultural: - rates of disorder differ between racial and ethnic groups - 2.1% of A.A. are diagnosed compared with 1.4% European Americans - A.A.s are also overrepresented in state hospitals most likely due to clinicians being unintentionally biased in their diagnosis or may misread cultural differences as symptoms - this could also be related to economics in that A.A.s are more likely to be poor - Hispanic Americans are also more likely to be diagnosed (but to the same degree that A.A.s are) - supported by the fact that when economic differences are controlled for, the rates of schizophrenia become closer Social Labeling: - theorists believe that the feature of schizophrenia are influenced by the diagnosis itself - society labels people who fail to conform to certain norms - once assigned, the label becomes a self-fulfilling prophecy - people may come to accept their assigned role and play it convincingly - supported by Rosenhan's "pseudo-patient" study Family dysfunction: - a number of studies suggest that schizophrenia is often linked to family stress - parents of those with the disorder often display more conflict, have greater difficulty communicating, and are more critical of and over involved with their children - families of those affected are high in "expressed emotion", which refers to the frequency at which they express criticism and hostility and intrude on each other's privacy - return to such environments is often linked to relapse (4x's more likely to relapse when return to family with high expressed emotion) - people with this disorder also tend to greatly disrupt family life, and in doing so, they themselves may help produce these family problems

Psychosis

- state defined by a loss of contact with reality - symptoms include hallucinations AND/OR delusions - functioning is significantly impaired - psychosis may be substance-induced OR caused by brain injury **BUT most psychoses appear in the form of schizophrenia

State hospitals

- state-run mental institutions that operated more on the idea of moral treatment - from 1845 - 1955, 300 state hospitals were built - in the same span of time, patients increased from 2,000 to 600,000! - the intent was to provide more intent and personal care, but problems with overcrowding, understaffing, poor patient outcomes, and decreased funding led to the inability to achieve this ideal - eventually, overcrowding, understaffing and poor patient outcomes lead to a loss of individual, humanitarian care to the creation of "back wards" and attempts to just keep order

Neuroleptic Malignant Syndrome

- suffered by 1% of patients (esp. older ones) - characterized by a severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system

Prodromal phase

- symptoms begins to show up - cannot diagnose disorder at this stage - symptoms are mild/not significant enough for dianosis

amenorrhea

- the absence of menstruation

lanugo

- the appearance of fine, soft hair (like the hair found on newborns) on the arms and legs of individuals with anorexia - this acts as the body's strategy to protect itself against the heat loss associated with extreme thinness

Characteristics of the HYPOTHALAMUS in the eating disorder-related brain circuit

- theorists believe that the hypothalamus (lateral and ventromedial), related areas, and other chemicals are responsible for establishing a weight "set point" - this mechanism is responsible for keeping an individual at a particular wight level - as sufferers lose wight, their body tells them to get hungry and eat in an effort to return to that weight set-point, which creates the conflict that causes them distress and ultimately leads to E.D.s - in other words, dieters end up in a battle agains their bodies to lose weight as they try to remain at a low body weight while their body is trying desperately to get weight back up to the set point - the lateral hypothalamus (side areas) produces hunger when activated (even if the subject just ate) - the ventromedial hypothalamus (bottom and middle of hypothalamus) reduces hunger when activated so subjects stop eating **when weight falls below the set point, the LH and other brain areas are ACTIVATED and seek to restore the lost weight by producing hunger and lowering the body's metabolic rate (the rate at which the body expends energy) **when weight rises about the set point, VMH and other brain areas are ACTIVATED and metabolic rate will increase

Positive symptoms of Schizophrenia

- these symptoms are characterized as bizarre ADDITIONS to typical thought, emotions, or behavior - in other words, they are excesses to experience that are pathological These symptoms include: - disordered thinking and speech (formal thought disorders), which may include loose associations, neologisms, perseverations, and clang - delusions - hallucinations - inappropriate affect **80-85% of schizophrenia cases are dominated by these types of symptoms

Cognitive-behavioral treatment for Bulimia nervosa

- this type of therapy is especially helpful - 75% of those treated with this type of therapy stop or reduce binge/purge behavior to the point that they no longer meet diagnostic criteria - this type of treatment is used FIRST Behavioral techniques: - diaries are often used - Exposure and Response Prevention (ERP) is often used to break the binge-purge cycle - in ERP therapy, therapists expose their clients to situations that would normally raise their anxiety and then PREVENT them from performing the compensatory behaviors that would normally give them some sort of relief from this anxiety - they continue to do this until the client learns that the situation is harmless and their compulsive acts are unnecessary EX: - therapist asks her client to eat a certain food but then prevents them from vomiting to show that eating can be harmless and even constructive - this technique reduces anxieties about food, bingeing, and vomiting Cognitive techniques: - encourage clients to recognize and change their maladaptive attitudes toward food, eating, weight, and shape - encourage clients to identify and challenge the negative thoughts that precede the urge to binge

Treatment for Bulimia Nervosa

- treatment is more often treated on an outpatient basis in eating disorder clinics - these clinics offer nutritional rehab and a combination of therapies aimed at achieving the primary goals of treatment - the primary goals of this treatment is to eliminate binge-purge patterns and establish good eating habits AND to eliminate the underlying psychological causes of bulimic patterns - programs emphasized education as much as therapy - 43% of those affected seek treatment **Treatments are divided into Cognitive-behavioral therapy, interpersonal psychotherapy, and antidepressant drug therapy

Strengths of Bulimia nervosa treatments

- treatment provides moderate to significant improvement in ~80% of cases (left untreated, it can last for years) - 75% of those affected have fully or partially recovered 10yrs. after treatment - psychotherapy is more effective than drugs - BUT psychotherapy WITH drugs is more effective than either treatment on its own

Moral Treatment

- treatment shifted from restraint and meeting basic human needs to treating those affected with kindness and sympathy - they now sought to remove daily stresses and offer healthy environments that are more serene and peaceful for recovery - such places were often state hospitals, which were often on the outskirts of town, away from society - this form of treatment was not quite as nice as it seems - beatings, teeth puling, "the swing" and other such practices were still used until the 1950's

Pedohebephilic type

- type of pedophilia in which the person is attracted to BOTH prepubescent AND early pubescent children

Hebephilic type

- type of pedophilia in which the person is attracted to early pubescent children

Classic type

- type of pedophilia in which the person is attracted to prepubescent children

Antidepressants with Bulimia nervosa

- unlike with anorexia, people with bulimia are often helped considerably by these drugs - drugs help as many as 40% of patients - reduces binges by 67% - reduces vomiting by 56% - works best in combination with cognitive-behavioral therapy

Psychomotor symptoms

- unusual movements or gestures - slow movements - repeated grimaces - often have private purpose - extreme form of these symptoms = catatonia - catatonic stupor = people stop responding to environment and remain motionless and silent - catatonic rigidity = people maintain a rigid, upright posture and resist efforts to be moved - catatonic posturing = assuming awkward/bizarre positions for long periods of time - catatonic excitement = move excitedly sometimes with wildly waving arms and legs

Characteristics of the ORBITOFRONTAL CORTEX in the eating disorder-related brain circuit

- unusually large - also functions in the OCD-related circuit

Interpersonal psychotherapy for Bulimia nervosa

- used to improve interpersonal functioning - this therapy may be conducted in a group format - family therapy may be included as a supplement - group therapy is helpful in up to 75% of cases

Evolution of gender variation

- was first referred to as EGO DYSTONIC HOMOSEXUALITY, which was defined as the experience of extreme distress over one's homosexual orientation - in 1987, this term was replaced with TRANSGENDER IDENTITY DISORDER - in 2013 this term was modified yet again into GENDER DYSPHORIA, which is how it appears now in the DSM-5

Strengths of Anorexia nervosa treatments

- weight gain is often quickly restored - 75% of those treated still showed improvements after several years - menstruation returns in women and other medical improvements are often observed - death rate is declining (death usually results from suicide, starvation, infection, GI problems, or electrolyte imbalances) - best results are obtained when this treatment is supplemented with other therapies (esp. family therapy) - this treatment is also better at preventing relapse when it continues for AT LEAST one year beyond recovery (maintenance therapy)

Main eating disorders

1. Anorexia nervosa 2. Bulimia nervosa 3. Binge eating disorder

Two main subtypes of anorexia nervosa

1. Restricting type 2. Binge/purging type

Symptoms of anorexia nervosa

1. SIGNIFICANTLY LOW body weight due to restricted intake of nourishment (less than 85% of normal body weight given what is recommended considering their height) 2. intense fear of gaining weight - and/or persistent behavior that interferes with weight gain 3. distorted views of weight and shape (cognitive symptom) - these distorted views include misperceptions of their size, the perception of their body as much bigger than it really is, and a low opinion of this body shape - individuals typically see their body size as 20% thinner to 20% larger than it actually is **key goal is to become thin; driven/motivated primarily by FEAR (i.e. the fear of losing control over size and shape of body) **despite their dietary restrictions, people with this disorder are preoccupied with food (i.e. they think, read, and dream about food and planning for meals) **this may be a RESULT of food deprivation rather than its cause

2 categories of sexual disorders

1. Sexual dysfunction - problems with sexual response cycles (difficulties in some or all parts of the cycle) 2. Paraphilic disorders - repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations **DSM-5 also includes Gender Dysphoria - a sex-related pattern in which individuals feel that they have been assigned to the wrong sex, strong wish to be member of another gender, and experience significant distress or impairment

What is the peak age of onset for those with anorexia nervosa?

14-20yrs. old

Peak age of onset of bulimia nervosa

15-20yrs.

What percentage of binge eating disorder cases occur in women?

64%

What % of anorexia nervosa cases occur in women?

75-90%

What % of bulimia nervosa cases occur in women

75-90%

Causes of Schizophrenia: Psychological

Cognitive-Behavioral (emphasis on behavior): - behaviorists cite OPERANT conditions and principle of reinforcement as the cause of schizophrenia - they propose that some people are NOT rewarded for their attention to social cues and, as a result, they stop attending to those cues and focus instead on irrelevant cues (i.e. room lighting) - their responses become increasingly bizarre yet are reward with attention, which makes them more likely to be repeated - treatment based on operant conditioning is relatively effective but doesn't do much to explain the disorder very well Cognitive-Behavioral (emphasis on cognition): - cognitive theorists agree that biological factors produce symptoms and propose that further features of the disorder emerge because of faulty interpretation and a misunderstanding of symptoms - there is little direct research support for this view - emphasizes cognitive misinterpretations of those with the disorder - they argue that the disorder emerges when individuals attempt t understand their unusual experiences - delusions of persecution are common - according to this theory, those affected take a "rational path to madness" in which they draw incorrect and bizarre conclusions - this process is helped along by a cognitive bias that many people with schizophrenia have that causes them to jump to conclusions very readily

Notable differences between Bulimia nervosa and Anorexia nervosa

Individuals with bulimia ONLY: - more concerned about pleasing others, being attractive to others, and having intimate relationships - more sexually experienced/active - more likely to have a long history of mood swings, being easily frustrated or bored, and having trouble coping effectively/controlling impulses or strong emotions - 1/3 of sufferers are also diagnosed wit a personality disorder (borderline or avoidant) - only 1/2 become amenorrheic (almost ALL cases of anorexia are marked by amenorrhea) - experience a potassium (K+) deficiency, which often leads to weakness, intestinal disorders, kidney disease, or heart damage

Causes of Schizophrenia: Biological

Genetics: - genetic researches believe that some people inherit a biological predisposition to schizophrenia - family pedigree studies repeatedly show that this disorder is more common among relatives of people with the disorder - the more closely related they are to the person with the disorder, the more likely they are to develop the disorder themself - studies indicate possible gene defects on the "X" chromosome, which may predispose some to this disorder - this is most likely a polygenic disorder (caused by a combo of genetic defects) Biochemical abnormalities: - neurons that secrete dopamine fire too often, producing symptoms of schizophrenia (Dopamine hypothesis) - this may explain the (+) symptoms associated with this disorder - this theory is largely based on the effectiveness of antipsychotic medications - antipsychotics reduce (+) symptoms by binding to dopamine receptors on postsynaptic neurons and prevents dopamine binding along with neuron firing - the dopamine hypothesis has been challenged by the discovery of atypical antipsychotics, which bind to multiple receptors and are more effective in that they treat (+) AND (-) symptoms - therefore, it's likely that schizophrenia is associated with abnormal activity of not just dopamine, but other neurotransmitters and brain structures within a larger circuit Brain Circuitry: - schizophrenia related brain circuit consists of the prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra brain activation and interconnectivity varies depending on the situation and structures (this circuit cannot be generally characterized as "less" or "more" active) - disorder may be linked to decreased interconnectivity between the substantial nigra and the prefrontal cortex; between the thalamus and the prefrontal cortex; or between the hippocampus and the prefrontal cortex - (+) symptoms are related to dysfunction of substantia nigra and striatum - (-) symptoms linke to dysfunction in hippocampus and amygdala - dopamine activity is prominent in ALL structures - substantia nigra and the striatum are usually HYPER active Viral Problems: - some suggest that the biochemical and structural brain abnormalities seen in schizophrenia result from exposure to viruses before birth - supported by evidence showing that mothers of children with this disorder were more often exposed to the influenza virus during pregnancy - the idea is that the viral infection triggers an immune repose in the mother, which is passed on to the developing fetus, enters his/her brain, and interrupts proper brain development - babies born in winter (flu season) are 5-8% more likely to develop the disorder (circumstantial evidence) - a link between schizophrenia and antibodies to a particular group of viruses found in animals suggests that people had at some point been exposed to those particular viruses **These biological explanations have received the most research support, but they are only part of the explanation - some people with these biological problems never develop the disorder (linked to diathesis stress)

Brain Circuit associated with eating disorders

Made up of the: - insula - orbitofrontal cortex - striatum - prefrontal correct - lateral hypothalamus (LH) - ventromedial hypothalamus (VMH) - various neurotransmitters and hormones **biological theorists believe that dysfunction in this circuit may be the cause of E.D.s **HOWEVER, dysfunction in this circuit could also be a RESULT of eating disorders, which reflects the those with E.D.s also suffer from other mental health disorders

Western society today equates health and beauty with what?

thinness