Abnormal Psychology Oltmanns Exam 3 - Chapter 9, 10, 11

How does bulimia nervosa affect the intestines?

constipation, irregular bowel movements, bloating, diarrhea, abdominal cramping

How does bulimia nervosa affect the stomach?

ulcers, pain, can rupture, delayed emptying

How to measure social impairment

using informant report (i.e. person is hard to like, difficult to get along with, etc)

subtypes of bulimia nervosa

(1) purging type (2) other compensatory actions

subtypes of anorexia nervosa

(1) restricting type (2) binge-eating/purging type

Levels of Personality Functioning

"gate keeper" that determines if the personal has a personality disorder

forms of personality disorders

(1) Cluster A - ODD, ECCENTRIC, paranoid pd, schizoid pd, schizotypal pd (2) Cluster B - DRAMATIC, EMOTIONAL, ERRATIC, histrionic pd, narcissistic pd, antisocial pd, borderline pd (3) Cluster C - ANXIOUS, FEARFUL, avoidant pd, dependent pd, obsessive-compulsive pd

health consequences of bulimia nervosa

(1) serious dental problems (2) lining of the mouth, throat, stomach develop problems (3) heart and kidney problems

biological etiology of antisocial personality disorder

(1) adoption studies point to influence of genetic factors (2) interaction bw genetic factors and rearing environment (3) adverse adoptive home environment increases risk of conduct disorder in offspring of antisocial parents

general criteria for personality disorders (DSM-5)

(1) an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture (2) manifested as one of these 2 ways: (a) cognition (b) affectivity (c) interpersonal functioning (d) impulse control (3) pervasive and inflexible (4) leads to distress or impairment (5) stable and long duration (onset traced to adolescence/early adulthood)

main points of eating disorders

(1) anorexia and bulimia more common among young women (2) increased prevalence of anorexia and bulimia in recent years (3) associated with a variety of comorbid disorders, both in people with eating disorders and their relatives (4) gender differences can in some ways be tied to sociocultural factors predisposing women to be concerned about and have unrealistic expectations for their appearance (5) eating disorders apparently produced by a combination of personal, environmental, biological, and dieting-related risk factors

psychological etiology of antisocial personality disorder

(1) avoidance learning in the lab (sequences) (2) psychopaths unaffected by anticipation of punishment (3) hypothesis 1: they can ignore the effects of punishment; they are emotionally impoverished (4) hypothesis 2: they have trouble shifting their attention; they are impulsive

problems with the categorical approach in the DSM (regarding personality disorders)

(1) considerable overlap among categories (2) problem setting thresholds (cut-off for diagnosis) (3) need for 10 diagnoses on Axis II creates unnecessary complexity (making decisions on 7 or 8 criteria for each category) (4) it might be simpler and more accurate descriptively to use a few dimensions

2 categories of problems with substance abuse that used to be in the DSM but have been removed

(1) dependence (2) abuse

associated features of anorexia nervosa (i.e. consequences from starvation)

(1) depressed mood (2) social withdrawal (3) irritability (4) insomnia (5) preoccupied with food

What are problems regarding personality disorders?

(1) diagnostic reliability is quite low (2) considerable overlap among categories (3) questions remain about stability over time (4) not clear that they are "culturally universal" (5) relatively less evidence to show that they can be treated successfully

Why are personality disorders a problem?

(1) disrupt interpersonal relationships (2) make therapy very difficult when they occur together with other disorders, such as depression and substance use disorders (3) may represent predispositions toward, or early manifestations of, other mental disorders

key symptoms of psychopathy

(1) emotional --> interpersonal (gib and superficial, ego-centric and grandiose, lack remorse or guilt, lack of empathy, deceitful and manipulative, shallow emotions) (2) social deviance (impulsive, need for excitement)

individual risk factors of eating disorders

(1) gender (2) age (3) internalization of thin ideal (4) perfectionism (5) negative body image (6) dieting (7) negative emotionality (8) childhood sexual abuse

2 goals of eating disorder treatment

(1) help the patient gain at least a minimal amount of weight (2) address the broader eating and personal difficulties

What is a personality disorder?

(1) hypothetical construct (like anxiety, intelligence, etc) (2) explanatory device (3) inferred internal event (cannot be seen directly) (4) has observable referents, but none define the construct exhaustively (5) defined in terms of a theoretical framework linking all of the referents

illegal vs illicit drugs

(1) illegal- not legally available, i.e. cannabis, cocaine, heroin (2) illicit- include psychoactive substances that may not be illegal but are misused, i.e. prescription drugs, naturally occurring hallucinogens

social etiology of antisocial personality disorder

(1) inconsistent discipline (or complete lack of discipline) often seen in the prior family history of antisocial men (2) kids with a "difficult temperament" are especially irritating to parents (3) parents respond inappropriately (giving up, or becoming severe in punishment) (4) person selects friends who share antisocial interests and problems

family risk factors of eating disorder

(1) limited tolerance of disharmonious affect or psychological tension (2) emphasis on propriety and rule-mindedness (3) parental over-direction of child or subtle discouragement of autonomous strivings (4) poor skills in conflict resolution (5) preoccupations regarding desirability of thinness, dieting, and good physical appearance

importance of eating disorders

(1) mean age of onset 17 years (2) high prevalence among high school and college girls (3) 40% of normal weight college women consider themselves fat (4) 80% report episodes that seem beyond their control (5) long term mortality rate for anorexia is approximately 6% (starvation, suicide, etc)

5 descriptors of personality disorders

(1) more subtle and less incapacitating than many mental disorders (2) rigid, inflexible, maladaptive patterns of relating to oneself and one's environment (3) presumably evident by adolescence and stable over the adult lifespan (4) most often untreated (5) ego-syntonic (thoughts, behaviors, and symptoms are acceptable and fit in with one's self image; disorders like depression and panic disorder are ego dystonic)

descriptors of bulimia nervosa

(1) most have normal body weight (2) binge on high-calorie foods (sweets) (3) binging is done secretly (4) leads to guilt, shame, disgust (5) more likely to have insight than people with anorexia (6) high co-morbidity with depression

traits in the new Dimensional Personality Disorder Model

(1) negative affectivity (2) detachment (3) antagonism (4) disinhibition (5) psychoticism

Why are personality disorders difficult to treat?

(1) person does not recognize they have a problem (2) interpersonal difficulties interfere with the therapeutic relationship (3) very little research evidence on treatment efficacy because personality disorders overlap so extensively with other mental disorders

how is personality expressed in terms of interpersonal relationships?

(1) social motivation (affiliation and achievement) (2) patterns of emotional expression (3) ways of thinking about ourselves and others

personality characteristics of women suffering from anorexia nervosa

(1) weight loss is viewed as an extraordinary achievement (2) lack of insight (limited self knowledge regarding weight problem) - deny problem, will wear baggy clothes, carry objects when weighed (3) excessive weighing, using mirrors to look for fat (4) brought to treatment by family members (not themselves) (5) conforming and eager to please (based on clinical folklore)

prevalence of bulimia nervosa

1% in general population; 3X more common in women than men; most likely to develop in women ages 20-24; mean age of those with bulimia is 35

prevalence of anorexia nervosa

0.5-1% in general population; 10X more common in women than men; most likely to develop between 15-19 years old

course of bulimia nervosa

10-11 years after diagnosis: 70% in remission (no longer meet diagnostic criteria), 30% continue to struggle

ratio of females to males suffering from an eating disorder

10:1

marijuana abuse and dependence

18% increase in the prevalence of cannabis use disorders amongst cannabis users in the last decade; cannabis use disorders are amongst the top unmet health needs worldwide; clinically valid and reliable syndrome; characteristics include anger, aggression, irritability, anxiety, restlessness, sleep problems, decreased appetite --> added to DSM-5

Hare's Psychopathy Checklist

20 items scored on a 3-pt scale (0, 1, 2), score above 30 used as cut-off; factor 1- personality (aggressive narcissism, selfish / callous / remorseless use of others); factor 2- case history (unstable antisocial and socially deviant lifestyle, many short-term marital relationships, criminal versatility); reactive and proactive aggression

course of anorexia nervosa

21 years after first diagnosis: 16% dead, 10% still have disorder, 21% partially recovered, 51% fully recovered

demographics of alcohol use disorders

2:1 men:women; highest severity in younger people and lowest in the elderly; highest prevalence in native americans and white people, african americans in the middle, lowest in hispanics and asians; more in single/widowed people than in married people; higher in college than high school ppl; higher severity in lower income people; higher rates in urban vs rural; most prevalent in west, then midwest, then NE, then south

mortality of anorexia nervosa

3% die from medical complications; suicide common- 50X that of the general population; mortality 12X higher for similarly aged females

prevalence of binge-eating disorder

3.5% in women; 2% in men

comorbidity of substance use disorders with other mental disorders

47% of people with schizophrenia are affected; 61% of people with bipolar disorder are affected; between 41-65% of those with an addictive disorder also have at least one mental disorder; 51% of those with a mental disorder have at least one addictive disorder; many people with three or more disorders have never received any treatment

alcohol use disorder lifetime prevalence in usa

50% of individuals 18+ are regular drinkers; Lifetime Prevalence of alcohol use disorder- 29.1%; 20% receive treatment; alcohol abuse 18%; alcohol dependence 12%; 24% with dependence receive treatment; 23.3% of people 12+ have history of binge-drinking; 12.4% of people 12+ have driven under influence in past year

behavioral addictions

BEHAVIORS THAT PRODUCE SHORT-TERM REWARD AND BECOME PERSISTENT DESPITE KNOWLEDGE OF ADVERSE CONSEQUENCES; i.e. pathological gabling

The Remains of the Day (1993 movie)

James Stevens' Obsessive-Compulsive Personality Features: (1) preoccupied with details, rules, and order (2) excessive devotion to work (3) rigid and stubborn (4) inflexible about matters of morality, ethics, and values (5) insists that others submit to his way of doing things (6) restricted expression of emotion (this item was dropped from the DSM)

DSM-5 Drug Use Disorders Severity Rating system

Mild: 2-3 symptoms; Moderate: 4-5 symptoms; Severe: 6-11 symptoms

the big 5 personality dimensions

OCEAN - Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism

most common form of personality disorder diagnosis

Personality Disorder Trait Specified

addictive drug

a chemical that is self-administered and leads to (1) compulsive use (2) tolerance and/or (3) withdrawal

Substance Dependence

a maladaptive pattern of substance use, leading to clinically significant impairment or distress, leading to tolerance and/or withdrawal symptoms; more severe form of substance abuse; involves a pattern of compulsive use, tolerance, and withdrawal

How does bulimia nervosa affect the skin?

abrasion of knuckles, dry skin

negative features of narcissism

abrasive and exploitative, disliked by others (but they may not care), interpersonal problems, mood fluctuations (especially anger), do not value empathy / compassion / ability to compromise

why was amenorrhea removed as a diagnostic criterion from the DSM-5 for anorexia nervosa?

absence of at least 3 consecutive menstrual cycles; dropped in part to make disorder gender neutral, bc most often consequence of starvation rather than as an individual sign of disorder; sometimes onset is before puberty; birth control reduces/changes periods; etc

marijuana

aka cannabis; psychoactive component is THC; absorbed through lungs ~10 minutes after inhalation; half-life of 3-5 days; interacts with cannabinoid receptors and modulates mood and thought; behavioral effects of THC- euphoria and relaxation, enhanced sensory perception, distortion of time and loss of memory, increased sociability, wear off causes lethargy and increased appetite, cannabis intoxication can cause anxiety and paranoia

drugs of abuse

aka psychoactive substance; a chemical that alters a person's mood, level of perception, or brain functioning

what does NOT classify as alcohol use disorders

alcohol use, casual drinking, glass of wine/few beers every day, heavy drinking/binge drinking (without symptoms), getting drunk;;;; bUT excessive/binge drinking and repeated drunkenness are hallmarks for DEVELOPING alcoholism

How does anorexia nervosa affect the intestines?

constipation, bloating

the FDA and nicotine

an intermediate policy- starts with the recognition that an outright ban would not be effective; attempts to prevent (or minimize) smoking among adolescents- sale to minors is illegal and taxes increased substantially, advertising is curtailed, education is enhanced

How does bulimia nervosa affect the blood?

anemia

How does anorexia nervosa affect the blood?

anemia and other blood problems

eating disorders across cultures

anorexia and bulimia are big problems in Asia; cases also documented in India and Africa, although less prevalent; prevalence in Iran is comparable to U.S.; Latinos born in the U.S. have a much higher rate than those who were born elsewhere; 58% in China report concern of stomach bloating (as opposed to concern of fatness); anorexic people in Ghana are not concerned about weight or shape; some debate exists regarding whether desire for thinness is a culture-bound presentation of anorexia

DSM-5 Drug Use Disorders criteria

at least 2 of 11 symptoms: (1) tolerance (2) withdrawal (3) use of larger amounts or for longer than intended (4) persistent attempts to quit or cut back (5) give up important activities to drink (6) spend a lot of time drinking or getting alcohol (7) physical or mental health problems due to alcohol use (8) failure to fulfill major role obligations (9) recurrent use in hazardous situations (10) recurrent interpersonal or social problems due to use (11) craving - strong urge or desire to use drug (new criterion)

physiological factors of alcohol use disorders

at risk if increased stress reduction following consumption, larger conditioned responses to alcohol cues, more positive expectations, self-medication for anxiety and/or stress; tension reduction hypothesis; expectancies; behavioral tolerance

cultural evolution of bulimia nervosa

binge eating is present across cultures and history; cases of mostly older men purging to alleviate physical pain due to overeating; few cases in adolescent women; appears only within westernized cultures; compensatory behavior related to fear of weight gain has notion present outside of western cultures; appears to be culture-bound

How does anorexia nervosa affect the skin?

bruise easily, dry skin, growth of fine hair all over body, get cold easily, yellow skin, nails get brittle

Personal Vulnerability Domains for onset of bulimia nervosa

bulimia patients way more likely to have 3-9 personal vulnerability factors; (1) childhood characteristics (i.e. negative self-evaluation, no close friends) (2) premorbid psychiatric disorder (i.e. major depressive disorder) (3) behavioral problems (i.e. conduct problems, school absence, deliberate self-harm) (4) parental psychiatric disorder (i.e. depression, alcoholism, drug abuse)

Dieting Vulnerability Domains for bulimia nervosa

bulimia patients way more likely to have 4-8 dieting vulnerability factors; (1) dieting risk (i.e. family members diet, critical comments from family about weight or shape) (2) obesity risk (i.e. parental obesity, childhood obesity) (3) parental eating disorder (either anorexia or bulimia)

Environmental Vulnerability Domains for onset of bulimia nervosa

bulimia patients way more likely to have 6-18 environmental vulnerability factors; (1) parental problems (i.e. separation from parents, criticism, minimal affection) (2) disruptive events (i.e. severe personal health problems) (3) teasing and bullying (not about shape/weight) (4) sexual or physical abuse

How are personality disorders defined in psychiatry?

by observations made by therapists while treating patients; a very different perspective

How does anorexia nervosa affect the brain and nerves?

can't think right, fear of gaining weight, sad, moody, irritable, bad memory, fainting, changes in brain chemistry

prevalence of cannabis use and misuse

cannabis is used in some form by 50-70% of population; lower use in females; cannabis abuse rates- males 4%, females 1% , higher in 18-29 year olds; cannabis dependence rates- males 2.5%, females 1.2%, higher in 18-29 year olds; mean age of onset of use= 17 years

cultural evolution of anorexia nervosa

cases of anorexia have been present throughout history, even among civilizations with no contact; modern day anorexia associated with drive for thinness and concern for weight, but it used to be attributed to holiness and moral determinism; evidence suggests anorexia nervosa is NOT culture-bound, but fear of being fat MAY be culture bound

How does bulimia nervosa affect the mouth?

cavities, tooth enamel erosion, gum disease, teeth sensitive to hot and cold foods

designer drugs

chemically mimic prescription/party drugs that may be illegal; chemical composition is mildly altered and drug is renamed so it is technically not illegal; can have additives that make them more dangerous than the illegal drug they are mimicking; often used widely until govt deems them illegal; i.e. synthetic marijuana, bath salts (MDPV - stimulant that is chemically similar to MDMA, sold at truck stops as bath salts, can cause psychosis and suicidality)

How does bulimia nervosa affect the body fluids?

dehydration, low potassium, magnesium, and sodium

How does bulimia nervosa affect the brain?

depression, fear of gaining weight, anxiety, dizziness, shame, low self-esteem

treatment of substance use disorders

detoxification; interventions vs motivational interviewing; self-help groups (i.e. alcoholics anonymous); relapse prevention (coping skills, abstinence violation effect); various programs reduce drug use and relapse is common; little reason to support one program over another; better attendance associated with improved outcome (personality?); people who do stop consumption see improvements in many areas (health, social functioning, work preferences)

Culture-Bound Syndrome

disorders that exist only within a specific culture (often a subculture within mainstream)

Conduct Disorder

evidence of Antisocial Personality Disorder before age 15; group of behavioral and emotional problems in children and adolescents, great difficulty following rules and behaving in a socially acceptable way, aggression to people and animals, destruction of property, deceitfulness, lying or stealing, serious violations of rules

social factors of alcohol use disorders

experimentation; parent modeling of appropriate vs inappropriate use of alcohol (influence attitudes and expectations, provide access and monitor use less closely, create a negative emotional climate); adolescents with alcoholic parents; high levels of negative affect in the home; girls with opposite-sex friends; cultural variations in rates of alcoholism

Psychopathy

extreme subset of those with antisocial personality disorder; not in DSM-5; rated on Hare's Psychopathy Checklist

Other Compensatory Actions Type Bulimia Nervosa

fasting, excessive exercise, manipulation of insulin doses

How does bulimia nervosa affect the muscles?

fatigue

Schizoid Personality Disorder

general: impaired social relationships, inability and lack of desire, little expression of emotion, more common in males than females; Cluster: A; main feature: pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings; trait descriptions: low extraversion (detachment), high neuroticism (negative affectivity); prevalence: 0.6% general population, uncommon in clinical settings; criteria (4+): neither desires nor enjoys close relationships including being part of a family, almost always chooses solitary activities, has little/no interest in sexual experiences with another person, takes pleasure in few if any activities, lacks close friends or confidants other than first-degree relatives, appears indifferent to praise or criticism of others, shows emotional coldness detachment or flattened affectivity

Obsessive-Compulsive Personality Disorder

general: a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, lack of warmth, difficulty relaxing, seen more in males than females; Cluster: C; main feature: preoccupation with orderliness, perfectionism, mental and interpersonal control, at the expense of flexibility, openness, and efficiency; trait description: high conscientiousness (disinhibition), high neuroticism, low openness, low extraversion; prevalence: 1.9% general population, more often diagnosed in males, different from OCD bc OCPD requires obsessions or compulsions; criteria (4+): preoccupation with rules / lists/order/organization / schedules to extent that the major point of the activity is lost, shows perfectionism that interferes with task completion, excessive devotion to work/productivity to the exclusion of leisure, over conscientious and inflexible about matters of morality /ethics/ values, unable to discard worn-out or worthless objects even when they have no sentimental value, reluctant to delegate tasks to others, adopts miserly spending style/ money hoarding for future catastrophes, rigidity and stubbornness

Schizotypal Personality Disorder

general: discomfort with close relationships, peculiar thought patterns, odd perception and speech, more common in males than females; Cluster: A; main feature: pervasive pattern of social and interpersonal deficits, marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior; trait description: higher neuroticism (negative affectivity), low extraversion (detachment), psychoticism; criteria (5+): ideas of reference (incorrect interpretations of causal incidents, external events having particular meaning), odd beliefs or magical thinking that influences behavior and is abnormal, unusual perceptual experiences including bodily illusions, odd thinking or speech, suspiciousness or paranoid ideation, inappropriate or constricted affect, behavior or appearance that is odd eccentric peculiar, excessive social anxiety (doesn't diminish with familiarity); treatment: most do not seek treatment - do not see own behavior as source of distress, often terminate treatment early, smaller dosage of antipsychotics has positive effects, some evidence that SSRIs may be beneficial, often don't respond well to psychotherapy; prevalence: 0.6%, slightly more common in males

Antisocial Personality Disorder

general: disregard for and frequent violation of the rights of others, lack of morals/ethics, usually seen in males, called Conduct Disorder before age 15 (group of behavioral and emotional problems in children and adolescents, great difficulty following rules and behaving in a socially acceptable way, aggression to people and animals, destruction of property, deceitfulness, lying or stealing, serious violations of rules), person's life options become narrowed which locks them into further antisocial behavior (Continuity in Life-Course-Persistent), limited range of behavior skills, ensnared by consequences of earlier behaviors; Cluster: B; main feature: pervasive pattern of disregard for and violation of the rights of others; trait description: low agreeableness (antagonism), low conscientiousness (disinhibition); criteria (3+ after age 15): repeated acts that could lead to arrest, conning for pleasure / profit and repeated lying and use of aliases, failure to plan ahead or being impulsive, repeated assaults on others, recklessness when it comes to their or others' safety, poor work behavior or failure to honor financial obligations, rationalizing the pain they inflict on others, **must be 18 years or older

Paranoid Personality Disorder

general: distrust/suspicious of others, self-blameless, more common in males than females; Cluster: A; main feature: pervasive distrust and suspicion of others such that their motives are interpreted as malevolent; trait description: low agreeableness, low openness, low extraversion; prevalence: 1.9% general population; criteria (4+): suspects without basis that others are exploiting harming or deceiving them, preoccupation with unjustified doubts about the loyalty of friends, reluctant to confide in others bc of fear that info will be used against them, reads hidden threats into benign remarks, peristyle bears grudges, perceives attacks on their character or reputation that are not apparent to others, recurrent suspicion without justification regarding fidelity of spouse or sexual partner

Histrionic Personality Disorder

general: excessive emotionally and attention seeking, concern with attractiveness, irritability and temper outbursts, similar prevalence in males and females, Scarlett O'Hara from Gone With the Wind was used as a prototype for HPD; main feature: pervasive pattern of excessive emotionality and attention seeking behavior; trait descriptions: high extraversion (low detachment), high neuroticism, low agreeableness, low conscientiousness; criteria (5+): uncomfortable when not center of attention, inappropriate sexually seductive/proactive behavior, rapidly shifting shallow expression of emotions, uses appearance to draw attention to self, theatrically exaggerated emotional expression, suggestible, considers relationships more intimate than they actually are

Dependent Personality Disorder

general: excessive need to be taken care of, submissive, clinging behavior, discomfort being alone, indecisiveness, similar prevalence in males and females; Cluster: C; main feature: pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation; causes: role of parenting; trait description: high neuroticism (negative affectivity), low conscientiousness (disinhibition); prevalence: 0.3% general population, diagnosed more frequently in females in clinical settings; criteria (5+): difficulty making everyday decisions without reassurance from others or excessive advice, needs others to assume responsibility for most major areas of life, difficulty expressing disagreement bc of lack of self-confidence, goes to excessive lengths to obtain nurturance from others, feels uncomfortable when alone bc of fears of being unable to care for self, urgently seeks new relationship as source of support when close relationship ends, unrealistically preoccupied with fears of being left alone to care for self

Narcissistic Personality Disorder

general: grandiosity, need for admiration, lack of empathy, more common in males than females; Cluster: B; main feature: pervasive pattern of grandiosity, need for admiration, and lack of empathy; trait description: low agreeableness, high extraversion (seen in Grandiose Narcissism), high neuroticism (seen in Vulnerable Narcissism); criteria (5+): grandiose sense of self-importance, preoccupation with fantasies of unlimited success/ power / brilliance/ ideal love, require excessive admiration, interpersonally exploitative, lacks empathy, sense of entitlement, envious of others or believes others envious of them, arrogant behavior/attitude, believes they are special and can only associate with important people

Binge-Eating/Purging Type Anorexia Nervosa

self-induced vomiting/ laxatives/ diuretics/ enemas, tend toward impulsiveness and substance abuse

Borderline Personality Disorder

general: instability of interpersonal relationships, self-image, emotions, and control over impulses, more common in females than males; Cluster: B; main feature: pervasive patter of instability of interpersonal relationships, self-image, and affects, and marked impulsivity; trait description: high neuroticism (negative affectivity), low conscientiousness (disinhibition), low agreeableness (antagonism); prevalence: 2.7% general population, most common PD in clinical settings, more commonly diagnosed in women, most severely dysfunctional PD; criteria (5+): frantic efforts to avoid abandonment, unstable intense interpersonal relationships, identity disturbance, impulsivity (sexual behavior, spending, substance abuse), suicidal behavior/ gestures / threats / self-mutilating behavior, affective instability, inappropriate intense anger, chronic feelings of emptiness, stress related paranoid ideation or dissociative symptoms

Avoidant Personality Disorder

general: sensitive to rejection, feelings of inadequacy, shy, insecure socially / social inhibition, similar prevalence in males and females; Cluster: C; main feature: pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation; trait description: high neuroticism (negative affectivity), low extraversion (detachment); prevalence: 1.2% general population, equal in males and females, substantial overlap with anxiety disorders; criteria (4+): avoids occupational activities that involve significant interpersonal contact bc of fears of criticism / rejection / disapproval, unwilling to get involved with people unless certain of being liked, shows restraint within intimate relationships bc of fear of being shamed or ridiculed, preoccupied with being criticized or rejected in social situations, inhibited in new interpersonal situations bc of fear of inadequacy, view of self as socially inept / personally unappealing / or inferior to others, reluctant to take personal risks bc they may prove embarrassing

How does anorexia nervosa affect the hair?

gets thin and brittle

cultural factors of eating disorders

great emphasis placed on women's appearance; eating disorders generally more common in industrialized countries; more common in higher socioeconomic groups; eating disorders are even more common among young women working in fields that emphasize weight and appearance, such as models, ballet dancers, and gymnasts

Why are some addicting drugs illegal?

has it always been that way? do they have serious negative effects on health while other drugs do not? is it for economic and political reasons?

positive features of narcissism

high self-esteem, high positive affect, optimistic about future, low anxiety, very competitive and ambitious, independent (good leaders?)

Twin Studies of alcohol use disorders

higher concordance rates in male twins make sense bc higher rates of alcoholism among men; heritability analysis suggests 2/3 of variance due to genetic factors for both men and women

Opponent-Process Model

i.e. morphine relieves pain (reduces pain sensitivity); the conditioned response is an increase in pain sensitivity; assume there is a hard-wired homeostatic process that suppresses some emotional and motivational states; anticipatory responses attenuate drug effects and contribute to tolerance; for many drugs the conditioned response is an anticipatory compensation; drug-associated environmental cues elicit responses that are opposite to the effect of the drug; the body essentially gets ready for the drug when in that environment

4 items that clinicians rate to determine if there is a personality disorder

identity, self-direction, empathy, and intimacy

legal drugs of use

in our society, nicotine, alcohol, and caffeine are available legally without a prescription; others, like benzodiazepines (i.e. valium, xanax) and certain opiates (i.e. morphine, methadone) can be prescribed by a physician

biological factors of alcohol use disorders

initial physiological reactions dramatically affect early drinking experiences; some people are unable to tolerate even small amounts of alcohol (skin flush); also nauseated and abnormal heartbeat; in males (but also shown in females)- neither parent alcohol dependent= risk-12.4%, 1 parent alcohol dependent= risk-30%, 2 parents alcohol dependent= risk-42%; children of parents with alcohol use disorders adopted by non-alcoholics 2X as likely

Fairborn's risk factors for bulimia study

interviewed 102 women with bulimia, control group- 204 healthy women, and 102 women with other psychiatric disorders; results: bulimia results from exposure to general risk factors for psychiatric disorders PLUS risk factors for dieting

How does bulimia nervosa affect the heart?

irregular heart beat, heart muscle weakened, heart failure, low pulse and blood pressure

How does bulimia nervosa affect the hormones?

irregular or absent period

treatment for alcohol use disorders

it's difficult bc people have a lot of denial and often need to hit rock bottom before seeking treatment; biological- medications to block desire (Antabuse- causes vomiting upon ingestion of alcohol (negative reinforcement), Naltrexone- opiate antagonist that reduces craving, tranquilizers to reduce withdrawal symptoms), reduce withdrawal side effects; psychological- group therapy (12 step program - i.e. AA, studies show that this is effective), environmental intervention, cognitive-behavioral therapy (heavy drinking is viewed as learned maladaptive coping mechanism, identify antecedents and consequences of drinking, teach new coping skills)

How does anorexia nervosa affect the kidneys?

kidney stones, kidney failure

anorexia nervosa

lack of maintaining minimal normal body weight - 85% or less of expected weight (of BMI minimum); intense fear of gaining weight or becoming fat; disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

cultural variation in alcohol use disorders

less common in Mediterranean cultures and those of Mediterranean descent; very low rates of alcoholism in muslims, mormons, orthodox jews

How does anorexia nervosa affect the heart?

low blood pressure, slow heart rate, fluttering of the heart (palpitations), heart failure

How does anorexia nervosa affect the body fluids?

low potassium, magnesium, and sodium

mortality for bulimia nervosa

lower mortality rate than anorexia nervosa; more suicide attempts than general population, but not a higher rate of success

treatment for bulimia

medication, cognitive behavioral therapy, interpersonal behavioral therapy, SSRIs (relapse is common after termination), research methods

effect of ethnicity on eating disorders

much more common in European-Americans; European Americans and Asian Americans have more body dissatisfaction, dietary restraint, and drive for thinness relative to African-Americans; minorities adopting white middle class attitudes show same rates as white middle class; ethnic identity- strong self-reported African American identity (regardless of race)= reduced risk of developing eating disorders

gender differences in eating disorders

much more common in females than males; possible explanation: different in source of self esteem - for adolescent girls, physical attractiveness predicts self esteem, and for adolescent boys, physical competence predicts self esteem

Main Traits of Borderline Personality Disorder

negative affectivity: emotional lability, anxiousness, separation anxiety, depressively; antagonism: manipulativeness, attention seeking, hostility; disinhibition: impulsivity, risk taking

Main traits of Narcissistic Personality Disorder

negative affectivity: n/a; antagonism: grandiosity, attention seeking; disinhibition: n/a

Main traits of Anti Social Personality Disorder

negative affectivity: n/a; antagonism: manipulativeness, deceitfulness, callousness, hostility; disinhibition: impulsivity, irresponsibility, risk taking

Main traits of Obsessive-Compulsive Personality Disorder

negative affectivity: perseveration; antagonism: n/a; disinhibition: rigid perfectionism

compulsivity

negative reinforcement (take more of drug to avoid negative effects)- relief of anxiety, withdrawal impairment

definition of bulimia nervosa remission

no eating problems for at least 6 months

Korsakoff's Syndrome (aka Alcohol Amnestic Disorder)

one of the most severe outcomes of substance abuse; symptoms: (1) memory deficit (most often to recent events (2) confabulation (falsification of events) (3) may not recognize people or objects that have just seen (4) fill memory with made up and fanciful tales; occurs following many years of heavy use; may be the result of vitamin B deficiency

Siegel's study of heroin overdose deaths

overdose deaths in humans are mysterious and may results in part from a failure of tolerance; injected rats with heroin every other day 15 times per day with amount per dose slowly increasing; eventually built up tolerance during second week; control rats received 30 daily injections of dextrose, all rats received one 15mg/kg dose of heroin at the end; similar tested rats received final high dose in same cue context as before, while differently tested rats (second group) received in different cue context not previously associated with the drug; results: highest mortality among control (no tolerance), second highest among differently tested rats (bc different context)

other addictive behaviors

pathological gambling, internet gaming disorder, hypersexual disorder, impulse control disorders, intermittent explosive disorder, kleptomania, pyromania

How does anorexia nervosa affect the hormones?

periods stop, problems growing, trouble getting pregnant, if pregnant higher risk for miscarriage, having C-section, baby with low birthweight, and postpartum depression

gambling disorder

persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, and at least 4+ in 12-mo period: (1) needs to gamble with increasing amounts of money to achieve the desired excitement (2) is restless or irritable when attempting to cut down or stop gambling (3) has made repeated unsuccessful efforts to control / cut back/ stop gambling (4) is often preoccupied with gambling (5) often gambles when feeling distressed (6) after losing money gambling, often returns another day to get even (7) lies to conceal the extent of involvement in gambling (8) has jeopardized or lost relationships, job, or educational opportunity by gambling (9) relies on others to provide money to relieve subsequent desperate financial situations

benefits of the big five personality dimensions in explaining personality disorders

personality disorders are maladaptive configurations of these personality traits, or are extreme variants of normal traits; explains comorbidity; minimize problem of heterogeneity; explains gender differences in prevalence rates (men usually lower in agreeableness, women usually higher in neuroticism); explains changes over time; useful in treatment (strengths and weaknesses, predicts outcome variables)

impulsivity

positive reinforcement (take more of drug to reinforce subjective high)- arousal, gratification, pleasure

conditioning view of drug tolerance

psychological factors are involved in the development and maintenance of tolerance; tolerance is in part environment-specific; hinges on classical conditioning

Bulimia Nervosa

recurrent episodes of binge eating characterized by (1) eating a very large amount of food within a 2-hour period (2) a sense of lack of control over eating during this episode; recurrent inappropriate compensatory behavior such as self-induced vomiting (3) binging and compensatory behaviors occur at least once a week for 3 months (4) self-evaluation unduly influenced by body shape and weight (5) doesn't occur exclusively during episodes of anorexia nervosa

Binge Eating Disorder

recurrent episodes of binge eating characterized by (1) eating an amount of food within a 2 hour period that is definitely larger than what most people would eat in a similar period of time under similar circumstances (2) a sense of lack of control over eating during the episode (i.e. a feeling that one cannot stop eating or control what or how much one is eating); the binge eating episodes are associated with 3 or ore of the following: (1) eating much more rapidly than normal (2) eating until feeling uncomfortably full (3) eating large amounts of food when not feeling physically hungry (4) eating alone bc of feeling embarrassed by how much one is eating (5) feeling disgusted with oneself, depressed, or very guilty afterward

Polivy and Hermann's research program on dietary restraint (page 276, ch 10)

restrained eaters more likely to binge after violation of diet, perfectionism is a large predictor

Restricting Type Anorexia Nervosa

rigid adherence to diet or exercise, tend toward compulsive personality, inflexible, strict about rules and morals

developmental framework of substance use disorders

sequence of stages - (1) initiation and continuation (2) escalation and transition to abuse (3) development of tolerance and withdrawal

hypersexual disorder

sex addiction, rejected for DSM-5; informal use of word addicting,; is it a problem of compulsion or addiction? or just an excuse for bad behavior?; extremely vulnerable to cultural bias; Over a period of at lest 6 months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following criteria: (1) Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual goals, activities and obligations (2) Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability) (3) Repetitively engating in sexual fantasies, urges or behaviors in response to stressful life events. (4) Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors (5) Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others

eating disorder treatment

some evidence that family family is more effective than individual therapy; treatment is difficult, often bc the patient is not interested; for anorexic patients, 17% are committed against their will; hospitalization can lead to competitive comparative pressure

Alcohol Withdrawal Delirium

sometimes happens to those who drink extensively for a long time; usually occurs following a prolonged drinking spree; disorientation to time and place, vivid hallucinations, acute fear, extreme suggestibility, physiological symptoms, lasts 3-6 days; death rate ~10% due to physiological symptoms

How does bulimia nervosa affect the throat and esophagus?

sore, irritated, can tear and rupture, blood in vomit

illegal drugs of use

stimulants (i.e. cocaine, ampehetamines), opiates (i.e. heroin), hallucinogens (i.e. LCD)

personality

study of individual differences

How does bulimia nervosa affect the cheeks?

swelling, soreness

withdrawal

symptoms experienced when a person stops using a drug

tolerance

the nervous system becomes less sensitive to the effects of substance; person needs larger quantities of the drug to achieve the same effects; potential reasons- (1) metabolic reasons (i.e. liver breaks down drug more efficiently) (2) pharmacological reasons (i.e. synaptic down-regulation) (3) behavioral reasons (i.e. classical conditioning)

personality disorders as constructs

they literally just don't exist; they are simply more or less useful; to determine whether a construct is useful we need to collect data; validity is an empirical question; to say that a construct is completely meaningless is a very strong statement and most likely an exercise in rhetoric - aka even if it is a construct it still has harmful effects and is therefore important

etiology of substance use disorders

think in terms of integrated systems; 1/10 drinkers will develop serious problems; biological factors are obviously involved (only certain kinds of drugs are addicting); social factors are also involved (why people drink/drug in the first place); developmental framework (sequence of stages - (1) initiation and continuation (2) escalation and transition to abuse (3) development of tolerance and withdrawal))

ego-syntonic

thoughts behaviors, and symptoms are acceptable and fit in with one's self image; characteristic of personality disorders

most prevalent drugs used/dependence

tobacco (24%), alcohol (14%), cannabis (4%), cocaine (3%)

psychological factors of alcohol use disorders

traditional behavioral view of alcoholism focused on immediate subjective effects of alcohol (presumably to reduce tension); lab studies showed variable effects; attention allocation model- helps explain inconsistencies (alcohol myopia- short sighted info processing); "drunken excess" will occur when strong cues pull for a response and the response is usually inhibited by higher level cognitive processes; lab studies show that some effects of alcohol are due to what people THINK it will do to their behavior- "balanced placebo design" used to study these effects, shows expectancy effects for loss of control drinking/aggression/ sexual arousal/etc

treatment for anorexia

variety of treatments tried, little to no evidence of efficacy

Purging Type Bulimia Nervosa

vomiting or laxatives

Substance Abuse

was presumably a less severe form of disorder, in which drug use interferes with the person's ability to function; "harmful consequences" without evidence of tolerance, withdrawal, or compulsive use

How does anorexia nervosa affect the muscles, joints, and bones?

weak muscles, swollen joints, bone loss, fractures, osteoporosis

men vs women body image rating scale test

women with eating disorders rate their ideal body type as very low, an attractive body type as lower than the attractive body type of the opposite sex, and their current body type as way higher than the ideal; men rated their ideal, attractive, and current body type all the same, and rated female attractive as a little lower