Abnormal Psych Unit 4
Which one of the following statements is NOT true about anorexia nervosa?
About 25 percent of people who experience anorexia nervosa are men.
The Typical Progression of Anorexia Nervosa
A normal to slightly overweight female has been on a diet. Escalation toward anorexia nervosa may follow a stressful event (e.g., separation of parents, move away from home, experience of personal failure). most individuals recover
"Alcoholism is a disease; you are an alcoholic for life, and must stop drinking." The treatment favored by the person/group being quoted MOST likely is
Alcoholic Anonymous.
Biological Factors
Biological theorists suspect certain genes may leave some people particularly susceptible to eating disorders. consistent with this idea: relatives of people with eating disorders are up to 6 times more likely to develop the disorder themselves identical (MZ) twins with anorexia: 70% fraternal (DZ) twins with anorexia: 20% identical (MZ) twins with bulimia: 23% fraternal (DZ) twins with bulimia: 9% These findings may be related to low serotonin levels
Cognitive Factors
Bruch's theory also contains several cognitive factors, like improper labeling of internal sensations and needs. According to cognitive theorists, these deficiencies contribute to a broad cognitive distortion that lies at the center of disordered eating (e.g., negative self-judgment based on body shape and weight).
group therapy
Group formats provide an opportunity for clients to express their thoughts, concerns, and experiences with one another. group therapy is helpful in as many as 75% of cases
Criminal Commitment and Competency to Stand Trial
Regardless of their state of mind at the time of a crime, defendants may be judged to be mentally incompetent to stand trial. If the court decides that the defendant is incompetent, the person is assigned to a mental health facility until competent to stand tria
substance-induced _________
Sometimes drugs create symptoms (e.g., depression, anxiety, hallucinations) that are similar to other psychological disorders, so we use this diagnosis to indicate that the symptoms are chemically induced.
Treatments for Anorexia Nervosa
In the past, treatment took place in a hospital setting; it is now often offered in day hospitals or outpatient settings. In life-threatening cases, clinicians may need to force tube and intravenous feedings on the individual
Criticisms of Civil Commitment
It is difficult to assess dangerousness. The legal definitions of "mental illness" and "dangerousness" are vague. civil commitment has questionable therapeutic value On the basis of these and other arguments, some clinicians argue that involuntary commitment should be abolished, whereas others advocate finding a more systematic way to evaluate dangerousness
Criticism of irresistible impulse test
It is difficult to distinguish an impulse that simply is not resisted from one that is irresistible
In response to a recommendation by the American Psychiatric Association regarding insanity pleas, current federal practice is MOST like the
M'Naghten
Emergency Commitment ("72-hour hold")
Many states give clinicians the right to certify certain patients as needing temporary commitment and medication. An emergency commitment requires the agreement of two physicians and/or mental health professionals.Traditionally, these certifications often are referred to as "2PCs" (two-physician certificates). The length of stay is often limited to three days
Overview of the Causes for Eating Disorders
Most theorists and researchers use a multidimensional risk perspective to explain eating disorders:several key factors place individuals at risk the more factors present, the greater the likelihood of developing a disorder leading factors: psychological problems (ego, cognitive, and mood disturbances)biological factors sociocultural conditions (societal, family, and multicultural pressures)
antidepressants
Prozac is the most commonly used drugs help as many as 40% of individuals with bulimia nervosa
According to studies regarding psychological disorders and prisoners, which statement is MOST accurate?
Psychological disorders are more common in prison populations than in the general population.
visceral hypersensitivity
People with anorexia are more aware of bodily "noise" (e.g., stomach rumbling, heart skipping a beat) than most people. The body's response to starvation is to slow down, which might quiet some of the bodily noise
Characteristics of Binges
People with bulimia nervosa may have between 1 and 30 binge episodes per week. These binges are often carried out in secret. Binges involve eating massive amounts of food very rapidly with little chewing.usually sweet, high-calorie foods with soft texture Binge-eaters commonly consume between 1,000 and 10,000 calories per binge episode. Binges are usually preceded by feelings of great tension and/or powerlessness. Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and being discovered.
criminal commitment
defendant is judged mentally unstable and sent to a mental health facility for treatment
Why is competence to stand stand trial so important?
defendants need to be able to understand the charges against them so that they can meaningfully participate in the criminal justice system punishment is only morally acceptable if the people understand why they are being punished the fairness and dignity of the adversary system requires that defendants be able to defend themselves against the charges brought against them
Other Psychological Problems of People with Anorexia Nervosa
depression (usually mild) anxiety low self-esteem insomnia or other sleep disturbances substance abuse obsessive-compulsive patterns perfectionism
If a person says, "I must be perfect in every way. I'll be a better person if I deprive myself of food," that person is engaging in
distorted thinking.
A person who had a serious mental illness and was in need of treatment could, nevertheless, not be civilly committed unless that person was also a danger
either to themselves or to others.
Overall Treatment Goals for Bulimia
eliminate binge-purge patterns establish good eating habits eliminate the underlying cause of bulimic patterns
irresistible impulse test
emphasized the inability to control one's actions the "fit of passion" defense
Ineffective parents
fail to attend to child's needs; they feed when the child is anxious, comfort when the child is tired, etc. Such children may grow up confused and unaware of their own internal needs and turn, instead, to external guides
vomiting
fails to prevent the absorption of half the calories consumed during a binge repeated vomiting affects the ability to feel satiated (full), which can lead to greater hunger and bingeing
The PRIMARY motivating emotion a person with anorexia experiences is
fear
If someone is interested in pursuing a career in a field that combined mental health and the legal and judicial systems, you should direct that person toward
forensic psychology.
laxatives and diuretics
also largely fails to reduce the number of calories consumed
civil commitment
an individual is forced to undergo mental health treatment, but the individual is not accused of a crime like in a criminal commitment
Compared to people with anorexia nervosa, MOST people with bulimia
are of more normal weight.
Women tolerate alcohol LESS well than men because they
have less of a stomach enzyme that breaks down alcohol.
What Happens if a Defendant is Found Incompetent to Stand Trial?
he/she is sent to a mental institution for treatment (criminal commitment) if competence is restored by treatment, defendant will then stand trial if still incompetent, stays in the mental institution
American Law Institute test
held that people are not criminally responsible if at the time of the crime they had a mental disorder or defect that prevented them from knowing right or wrong OR from being able to control themselves and to follow the law
Which one of the following combinations is MOST likely to result in antagonistic effects?
barbiturates and cocaine
Civil commitment is for a person who has
been forced to undergo mental health treatment.
If you received two-physician certificates, you would have
been involuntarily committed.
Immediately preceding the onset of an eating disorder, one would MOST likely find that the woman had
been successful in losing weight and had been praised by family.
Similarities Between Anorexia Nervosa and Bulimia Nervosa
begin after a period of dieting fear of becoming obese a drive to become thin preoccupation with food, weight, and appearance feelings of anxiety, depression, obsessiveness, and perfectionism heighted risk of suicide attempts substance abuse distorted body perception disturbed attitudes toward eating
The MOST accurate diagnosis for a woman who regularly eats a whole pizza, a carton of ice cream, and a box of donuts at one sitting, then forces herself to throw it all up is
bulimia nervosa.
altered reward system
bulimia: a weaker response to dopamine (getting less pleasure from eating, so they binge) anorexia: dopamine release in the brain from food stimuli creates anxiety rather than pleasure
Durham test
The first step in the process is answering the question of whether the defendant has a mental disorder.If the answer is "no," then he/she cannot plead not guilty by reason of insanity.If the answer is "yes," then we move the second question. The second question involves whether the crime committed was the direct result of the defendant's psychological disorder.If the the answer is "no," then, once again, the defendant cannot plead not guilty by reason of insanity.If, however, the answer is "yes," then the defendant can plead not guilty by reason of insanity
What must be true before a person may be tried for a crime and potentially found guilty?
The person must be capable of helping to defending him or herself in court.
Dusky Standard for Competence
This standard is based on the case of Milton Dusky, a 33-year-old man, who along with two teenage boys, kidnapped and raped a 15-year-old girl
A person who eats large amounts of food in a short period, and does this repeatedly, with no other symptoms, would be said to have
a binge-eating disorder.
Insanity
a legal term that refers to a defendant's mental state at the time the crime was committed
substance use disorders
a pattern of long-term problems brought on my continued use of a substance
Overview of Anorexia Nervosa
about 90%-95% of cases occur in females The peak age of onset is between 14 and 18 years. between 0.5% and 3.5% of females in Western countries develop the disordermany more display some symptoms Rates of anorexia nervosa are increasing in North America, Europe, and Japan
Effective parents
accurately attend to a child's biological and emotional needs
The stimulant used by MORE people in the world than any other is
caffeine
An individual who has recently taken a drug angrily grabs some car keys and attempts to drive home. The person appears anxious, and keeps bragging that driving the car won't really be that difficult. MOST likely, that person is experiencing
cocaine intoxication.
If a therapist thought that eating disorders were BEST explained by an interaction of sociocultural, psychological, and biological factors, that therapist would be taking a(an)
cognitive-behavioral perspective.
An acquaintance of yours uses Ecstasy and says, "Wow! I was totally energized and tripping. It was like LSD and meth combined." Your acquaintance's experience with Ecstasy was
common; the drug has both stimulant and hallucinogenic properties.
Someone who fasts or exercises strenuously following a binge is engaging in
compensatory behaviors.
What does Hilde Bruch believe ineffective parents do that puts their children at risk for eating disorders?
incorrectly interpret their children's needs
If a man walked in on his wife in bed with his best friend and killed both of them in a "fit of passion," that man may be eligible for an insanity defense under the
irresistible impulse test.
irresistible impulse test criteria
lack of apparent motive (helps rule out premeditation) suicidal ideation lack of accomplices (helps rule out premeditation) lack of escape plan (helps rule out premeditation) relief by the patient after the crime (killing) attacks on anyone at hand symptoms less evident to outside world
restricting type
lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food show almost no variability in diet The following video discusses Isabelle Caro's struggle with anorexia. It is not clear from the video, but I believe she would be diagnosed with the restricting subtype given what she says about herself
binge-eating/purging type
lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics like those with bulimia nervosa, people with this subtype may engage in eating binges In the following video, a young woman discusses the development, progression, and treatment of her struggles with this subtype
A young woman who is very concerned about being attractive to others, is more sexually experienced, and has relatively few obsessive qualities is
more likely to be experiencing bulimia than anorexia.
After an accident, Kendra was taken to the hospital with broken legs and arms. She was almost immediately given a shot that reduced her pain. The shot was MOST likely
morphine
Research suggests that people continue to use tobacco despite its health risks because
nicotine is so addictive.
If a court decides that a defendant is mentally unstable, the defendant will
not be punished in the usual way.
mentally unstable at the time of the crime
not guilty by reason of insanity, innocent of crime; receive mental health treatment rather than punishment
Which one of the following people would never have to stand trial for a crime he or she might have committed?
one judged not guilty by reason of insanity
Which one of the following drugs is a depressant?
opiods
Characteristics of Individuals with Anorexia Nervosa
preoccupation with food thinking and reading about food, collecting recipes, planning for meals distorted body perceptions
All of the following are compensatory behaviors for someone with bulimia EXCEPT
preoccupation with food.
What is the MOST common outcome for individuals with anorexia nervosa?
recovery
Competence
refers exclusively to the defendant's mental abilities at the time of the court proceedings
A client receiving treatment for substance abuse keeps track of times the substance is used, and develops strategies to deal with the substance when there is an opportunity to use it. The client is MOST likely receiving
relapse-prevention training.
mentally unstable at the time of the trial
remain in treatment until they can stand trial
Characteristics of Binge-Eating Disorder (BED)
repeated eating binges during which they feel no control over their eating These individuals do not perform inappropriate compensatory behavior. As a result of their frequent binges, around two-thirds of people with binge eating disorder become overweight or even obese. approximately 20% of individuals in weight-control programs suffer from BED approximately half of candidates for bariatric surgery suffer from BED better response to treatment than other eating disorders Individuals with BED tend to be older than sufferers of anorexia and bulimia. higher rates of psychopathology than non-bingeing obese individuals
The current trend in legislation and treatment regarding people who commit sex crimes and are also mentally ill is to
require both punishment for the crime and treatment.
Overall Goals of Treatment for Anorexia Nervosa
restore proper weight recover from malnourishment restore proper eating
2 Subtypes of Anorexia Nervosa
restricting type binge-eating/purging type
Of the following alternatives, the MOST commonly used form of treatment for a substance abuse disorder is
self-help groups.
Main Symptoms of Anorexia Nervosa
significantly low weightbody weight that is very low and below that of other people of similar age and gender intense fears of becoming overweight and persistent behavior that interferes with weight gain distorted body perception amenorrhea (no longer required
Researchers have found that substance use disorders are more common among some religious groups than others, and generally are more common among some groups than among others. Together, these findings provide the MOST support for which view of substance abuse disorders?
sociocultural
M'Naghten test
states that experiencing a mental disorder at the time of a crime does not by itself mean that the person was insane; the defendant also had to be unable to know right from wrong
What is the first type of food usually eliminated from the diet of the developing restricting-type anorexic person?
sweets
Amenorrhea
the absence of menstruation and, prior to DSM-5, was required for a diagnosis
A frequent drug user finds that larger doses of a drug are necessary to produce the same "high" that much lower doses once produced. That drug user is developing
tolerance.
A person takes a drug at noon. Although remaining awake and alert, the person experiences poor coordination, palpitations, and greatly enhanced visual perceptions. By dinner, the symptoms have pretty well subsided. MOST likely, that person
took LSD.
Treatments for Bulimia Nervosa
treatment is frequently offered in eating disorder clinics programs emphasize education as much as therapy
DSM-5 includes gambling disorder as an addictive disorder, along with substance abuse disorders. This inclusion is
unique; gambling disorder is the only disorder in the category that doesn't involve a substance.
Characteristics of People that are Found Incompetent
usually single males minorities low levels of education and intelligence unemployed previous involvement in legal and mental health systems exhibits symptoms of current serious mental disorder charged with more serious crimes
How is competence restored?
usually through psychoactive medication Defendants who received treatment involving videos and instructions on courtroom procedures in addition to medication were found more likely to be competent (43%) upon re-evaluation than those only receiving medication (15%).
Relapses of Bulimia
usually triggered by stress more likely among persons who: had a longer history of symptoms vomited frequently had histories of substance use have lingering interpersonal problems
habitual behavior
Anorexics' ability to avoid or restrict eating may be due to an area of the brain (dorsal striatum) related to habitual behavior rather being the result of greater willpower
Characteristics of Individuals with Bulimia Nervosa
Clients are generally of normal weight or slightly overweight often experience significant weight fluctuations some may also qualify for a diagnosis of anorexia nervosa binges compensatory behaviors
The version of the insanity defense that declares that a person cannot be held responsible for his or her actions if they were the result of mental disease or mental defect is called the
Durham test.
Psychodynamic Factors: Ego Deficiencies
Hilde Bruch developed a largely psychodynamic theory of eating disorders. She argued that eating disorders are the result of disturbed mother-child interactions, which lead to serious ego deficiencies in the child and to severe perceptual disturbances. Bruch argues that parents may respond to their children either effectively or ineffectively.
Who is Considered as Dangerous in Terms of Emergency Commitment?
Historically, people with mental illnesses were less likely than others to commit violent or dangerous acts because of mass hospitalizations. Since deinstitutionalization (discussed later in the course), however, this is no longer true.
Concerns about the insanity defense
One concern is the fundamental difference between the law and the science of human behavior.The law assumes that individuals have free will and are generally responsible for their actions.In contrast, several models of human behavior assume that physical or psychological forces act to determine the individual's behavior. A second criticism points to the uncertainty of scientific knowledge about abnormal behavior. The largest criticism is that the defense allows dangerous criminals to escape punishment
interpersonal therapy (IPT)
a treatment that seeks to improve interpersonal functioning may be tried
Characteristics of anorexia nervosa include all the following EXCEPT:
a view that one is currently unattractively thin.
A client being treated for alcohol abuse receives just enough of a drug called curare to produce temporary paralysis just as that client takes a swig of beer. Presumably, sufficient pairings of paralysis and alcohol will reduce the client's desire for alcohol. This procedure is called
aversion therapy.
Currently in the United States, patients who are criminally committed to a mental hospital can be released
when they are no longer considered insane.
