Exam 3
why is treating BPD essential
severity and high risk of suicide
Elena binges on high calorie foods and then makes herself throw up. She feels terribly ashamed and horrified by what she does. You would predict ________
she will not stop because her vomiting is reinforced by reducing her fear of gaining weight.
personality disorder
some people have certain traits that are so inflexible and maladaptive that they are unable to function effectively or meet the demands of their culture. In such cases we may say the person has a personality disorder. The general features that characterize most personality disorders are chronic interpersonal difficulties, problems with one's identity or sense of self, and an inability to function adequately in society
St. Catherine of Sienna
starve herself when she was around 16 years of age. She died in 1380 (at the age of 32 or 33) because she refused to consume either food or water (Keel & Klump, 2003)
Is ecstasy a stimulant or a depressant?
stimulant AND hallucinogen
the minnesota experiment
studied starvation to see how to refeed showed ED symptoms (ie watching ppl eat)
common targets of CBT in psychopathy
(1) increasing self-control, self-critical thinking, and social perspective taking; (2) increasing victim awareness; (3) teaching anger management; (4) changing antisocial attitudes; and (5) curing drug addiction
following alcohol, list most common drugs
(1) opiates, including opium and heroin; (2) stimulants such as cocaine and amphetamines as well as caffeine and nicotine (disorders associated with tobacco withdrawal and caffeine intoxication are included in the DSM-5 diagnostic classification system); (3) sedatives such as barbiturates; (4) hallucinogens such as LSD; (5) antianxiety drugs such as benzodiazepines; and (6) pain medications such as OxyContin
paranoid personality disorder and TBI/cocaine use
. Symptoms of paranoid personality disorder also seem to increase after traumatic brain injury and are often found in chronic cocaine users (see Hopwood & Thomas, 2012). In the following case, head trauma and alcohol abuse are both suggested as possible causal factors.
at what blood alcohol level does a person typically pass out
0.5
medications and AN
Antidepressants are sometimes used in the treatment of anorexia nervosa, although there is no evidence that they are especially effective (Brown & Keel, 2012b). In contrast, research suggests that treatment with an antipsychotic medication called olanzapine may be beneficial.
personality disorders around world
As with other forms of psychopathology, the incidence and particular features of personality disorders vary somewhat with time and place, although not as much as one might guess (Allik, 2005; Rigozzi et al., 2009). Indeed, there is less variance across cultures than within cultures. This may be related to findings that all cultures (both Western and non-Western, including Africa and Asia) share the same five basic personality traits discussed earlier, and their patterns of covariation also seem universal (see Allik, 2005, for a review).
at lower levels, what does alcohol do to the brain? how about higher levels?
At lower levels, alcohol activates the brain's "pleasure areas," causing the release of dopamine in the mesolimbic dopamine pathway (discussed later in this chapter) (Connor et al., 2016). At higher levels, alcohol depresses brain functioning, inhibiting one of the brain's excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the brain
How does cocaine affect the brain?
Cocaine has its primary effect by blocking the presynaptic dopamine transporter (whose job it is to retrieve excess dopamine from the synapse), thus increasing the availability of dopamine in the synapse and increasing the activation of the receiving cells. The increase of dopamine activity in the nucleus accumbens is believed to be especially important in cocaine addiction because specific parts of this brain region have been suggested to be "hedonic hot spots" that have been consistently associated with the experience of reward and pleasure
overview: antisocial personality disorder
Characteristics: Lack of moral or ethical development; inability to follow approved models of behavior; deceitfulness; shameless manipulation of others; history of conduct problems as a child Point Prevalence in General Population: 1% females, 3% males Gender Ratio Estimate: Males > Females
overview: histrionic personality disorder
Characteristics: Self-dramatization; overconcern with attractiveness; tendency to irritability and temper outbursts if attention seeking is frustrated Point Prevalence in General Population: 1.2% Gender Ratio Estimate: Females > Males
overview: paranoid personality disorder
Characteristics: Suspiciousness and mistrust of others; tendency to see self as blameless; on guard for perceived attacks by others, quick to anger Point Prevalence in General Population: 1.5% Gender Ratio Estimate: Males = Females
overview: schizotypal personality disorder
Characteristics: similar to schizoid but Peculiar thought patterns; oddities of perception and speech that interfere with communication and social interaction Point Prevalence in General Population: 1.1% Gender Ratio Estimate: Males > Females
psychological interventions and cocaine
Despite cocaine's addictive potential, psychological interventions have proven to be quite effective in successfully treating cocaine dependence. A recent review of 34 studies testing psychological treatments for substance use disorders evaluated in randomized controlled trials reported that both CBT (described earlier) and contingency management (CM) approaches are effective treatments for substance use disorders
do amphetamines give extra energy
Despite their legitimate medical uses, amphetamines are not a source of extra mental or physical energy. Instead, they push users toward greater expenditures of their own resources—often to the point of hazardous fatigue.
Psychopathy Checklist-Revised (PCL-R)
Developed by Robert Hare, it is the best-known and most heavily researched instrument for the measurement of criminal psychopathy.
shifts btwen BED and AN or BN
Diagnostic crossover from bulimia nervosa into binge-eating disorder occurs in about 10.9 percent of cases (Castellini et al., 2011). Finally, we note that binge-eating disorder and anorexia nervosa appear to be quite distinct disorders. Over the course of a 12-year follow-up, no patient with binge-eating disorder developed anorexia nervosa and no patient with anorexia nervosa developed binge-eating disorder
DBT vs routine treatment of BPS
Dialectical behavior therapy (DBT) appears to be an efficacious treatment for BPD. However, a recent meta-analysis suggests that the treatment gains are smaller than one might hope compared to routine treatment (Cristea et al., 2017). This may be because routine treatment for BPD has improved over time, making the differences between treatment as usual and DBT less marked. There are still not enough randomized controlled trials to say whether DBT works as well in men as in women, and whether it works well with minority patients (Lynch & Cuper, 2012). Patients receiving DBT show reductions in a broad range of outcomes including self-destructive and suicidal behaviors and levels of anger (Cristea et al., 2017; Linehan et al., 2006; Lynch et al., 2007). As a result of Linehan's many efforts to help clinicians learn her methods, DBT is increasingly available to patients. Briefer versions of the treatment are also being developed
drugs and treatment of BPD
Drugs are often used in the treatment of BPD. Indeed, many patients with BPD are taking multiple medications. Yet there is little evidence to support their use (Bateman et al., 2015). Antidepressant medications (most often from the selective serotonin reuptake inhibitors [SSRI] category) are widely used, although there is no compelling evidence that they are effective. They are most appropriate only when patients have a comorbid mood disorder (Silk & Feurino, 2012).
AN across cultures
Far from being confined to industrialized Western countries, eating disorders are becoming a problem worldwide. Being white, however, does appear to be associated with subclinical problems that may place individuals at higher risk for developing eating disorders
Which of the following best explains the lack of well-controlled studies on the effectiveness of treatment for anorexia nervosa?
Few people with anorexia are willing to seek treatment, and they are likely to drop out prematurely from treatment.
BN and BED long term outcomes
Finally, like patients with bulimia nervosa, patients with binge eating disorder also have high rates of clinical remission. Following a period of intensive treatment, two-thirds of a sample of 60 patients no longer had any form of eating disorder
Schizoid vs avoidant personality disorder
unlike schizoid personalities, people with avoidant personality disorder do not enjoy their aloneness. Avoidant individuals want contact with other people. However, their inability to relate comfortably to other people causes them acute anxiety. Such people tend to be rather aloof, cold, and relatively indifferent to criticism (Millon & Martinez, 1995). In contrast, the person with avoidant personality disorder wants interpersonal contact but is shy, insecure, and hypersensitive to criticism.
yearly prevalence of AUD
15%
why are personality disorders hard to research
1. high level of comorbidity btwn personality disorders 2. researchers have more confidence in prospective studies which there is little of in personality disorders
life span with AUD
12 years shorter
according to the PCL-R, what are the four dimensions of psychopathy
1a. The interpersonal dimension reflects a personality style that is characterized by glibness/superficial charm, a grandiose sense of self-worth, pathological lying, and the conning manipulation of others. 1b. The affective dimension reflects traits such as lack of remorse or guilt, callousness/lack of empathy, shallow affect, and a failure to accept responsibility for one's behavior. 2a. The lifestyle dimension reflects a need for stimulation, a tendency to be easily bored, impulsivity, irresponsibility, a lack of reasonable long-term goals, as well as a parasitic lifestyle. 2b. Finally, the antisocial dimension reflects the aspects of psychopathy that involve poor behavior controls, early behavior problems, delinquency, and criminality.
lifetime prevalence of BED
2
gender and AUD
2:1 W:M
lifetime prevalence of AUD
30%
gender and EDs
3:1 w:m
According to a 2018 Monitoring the Future study, what percentage of students in the United States report using illicit drugs at least once before finishing high school?
49
lifetime prevalence of BED in obese people
6.5 to 8
when did thinness become a cultural ideal
60s twiggy
prison population and ASPD vs psychopathy
70 to 80 percent qualify for a diagnosis of ASPD but that only about 25 to 30 percent meet the criteria for psychopath because they do not show enough selfish, callous, and exploitative behaviors to qualify for a diagnosis of psychopathy
schizotypal and schizophrenia
A genetic relationship to schizophrenia has also long been suspected. In fact, this disorder appears to be part of a spectrum of liability for schizophrenia and often occurs in some of the first-degree relatives of people with schizophrenia (Kendler & Gardner, 1997; Kwapil & Barrantes-Vidal, 2012; Raine, 2006; Tienari et al., 2003). The biological associations of schizotypal personality disorder with schizophrenia are remarkable (Cannon et al., 2008; Jang et al., 2005; Siever & Davis, 2004; Yung et al., 2004). A number of studies on patients, as well as on college students with schizotypal personality disorder (e.g., Raine, 2006; Siever et al., 1995), have shown the same deficit in the ability to track a moving target visually that is found in schizophrenia (Coccaro, 2001; see also Chapter 13). They also show numerous other mild impairments in cognitive functioning (Voglmaier et al., 2005), including deficits in their ability to sustain attention (Lees-Roitman et al., 1997; Raine, 2006) and deficits in working memory (e.g., being able to remember a span of digits), both of which are common in schizophrenia. In addition, individuals with schizotypal personality disorder, like patients with schizophrenia, show deficits in their ability to inhibit attention to a second stimulus that rapidly follows presentation of a first stimulus. teenagers who have schizotypal personality disorder have been shown to be at increased risk for developing schizophrenia and schizophrenia-spectrum disorders in adulthood
leptin
A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite.
causal factors in narcissism
A key finding has been that the grandiose and vulnerable forms of narcissism are associated with different causal factors. Grandiose narcissism has not generally been associated with childhood abuse, neglect, or poor parenting. Indeed, there is some evidence that grandiose narcissism is associated with parental overvaluation. By contrast, vulnerable narcissism has been associated with emotional, physical, and sexual abuse, as well as parenting styles characterized as intrusive, controlling, and cold
social anxiety disorder vs avoidant personality disorder
A much less clear distinction is that between avoidant personality disorder and social anxiety disorder (social phobia; Chapter 6). Numerous studies have found substantial overlap between these two disorders, leading some investigators to conclude that avoidant personality disorder may simply be a somewhat more severe manifestation of generalized social anxiety disorder (Alpert et al., 1997; Carter & Wu, 2010; Tillfors et al., 2004) that does not warrant a separate diagnosis (Chambless et al., 2008). This is consistent with the finding that there are cases of social anxiety disorder without avoidant personality disorder but very few cases of avoidant personality disorder without social anxiety disorder
why is reward sensitivity being studied in EDs
A new direction in eating disorders research centers on the brain pathways and neurotransmitters (such as dopamine) that are involved in reward processing. This makes a lot of sense because individuals who binge eat tend to consume high-fat and high-sugar foods that most of us tend to think of as rewarding. In contrast, being less sensitive to food reward may make it easier for some people to restrict their food intake, thereby increasing risk for the development of anorexia nervosa
alcohol and malnutrition
A pint of whiskey—enough to make about 8 to 10 ordinary cocktails—provides about 1,200 calories, which is approximately half the ordinary caloric requirement for a day. Thus, consumption of alcohol reduces a drinker's appetite for other food. Because alcohol has no nutritional value, the excessive drinker can suffer from malnutrition (Connor et al., 2016). Furthermore, heavy drinking impairs the body's ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Many people who abuse alcohol also experience increased gastrointestinal symptoms such as stomach pains
sex and histrionic personality disorder
A recent careful analysis of the issue suggests that the higher prevalence of histrionic personality in women actually would not be predicted based on known sex differences in the personality traits prominent in the disorder. This does indeed suggest the influence of some form of sex bias in the diagnosis of this disorder
prospective studies
A study that monitors people who might develop a disorder in the future
family influences in EDs
AN: family dysfunction, less cohesive rigid, poor communication parents want thinness, perfectionism BN: less cohesive, high parent expectation, critical comments
drug use stats
An estimated 27 million Americans ages 12 years or older report using at least one illicit drug during the past year, which is equal to about 10 percent of the U.S. population (SAMHSA, 2016). According to the Monitoring the Future study, 49 percent of U.S. students have used illicit drugs at least once by the time they finish high school
personal responsibility in AA
An important aspect of AA's rehabilitation program is that it appears to lift the burden of personal responsibility by helping alcoholics accept that alcohol use disorder, like many other problems, is bigger than they are. Henceforth, they can see themselves not as weak willed or lacking in moral strength but rather simply as having an affliction—they cannot drink—just as other people may not be able to tolerate certain types of medication.
causes of death in AN
After medical complications, the second most common cause of death in those who suffer from anorexia nervosa is suicide.
why is the liver damaged in chronic alcohol use
Alcohol that is taken in must be assimilated by the body, except for the approximately 5 to 10 percent that is eliminated through breath, urine, and perspiration. The work of alcohol metabolism is done by the liver, but when large amounts of alcohol are ingested, the liver may be seriously overworked and eventually suffer irreversible damage
black, white, and asian women and pathological eating
Although Asian women exhibit levels of pathological eating similar to those of white women (Wildes et al., 2001), it has long been held that African Americans are less susceptible to subclinical types of eating problems and body image concerns than Caucasians are.
psychosis and schizotypal
Although contact with reality is usually maintained, highly personalized and superstitious thinking is characteristic of people with schizotypal personality, and under extreme stress they may experience transient psychotic symptoms (APA, 2013; Widiger & Frances, 1994). Indeed, they often believe that they have magical powers and may engage in magical rituals. Other cognitive-perceptual problems include ideas of reference (the belief that conversations or gestures of others have special meaning or personal significance), odd speech, and paranoid beliefs. In fact, many researchers conceptualize schizotypal personality disorder as an attenuated form of schizophrenia
Which of the following statements about the role of genetics as a risk factor for eating disorders is true?
Although the findings to date are mixed, the evidence does indicate that a susceptibility to eating disorders may be inherited along with a diathesis for other psychological conditions.
OCD and OCPD
Although the name sounds similar, people with OCPD do not have true obsessions or compulsive rituals as is the case with obsessive-compulsive disorder (OCD; see Chapter 6). Indeed, only about 20 percent of patients with OCD have a comorbid diagnosis of OCPD. This is not significantly different from the rate of OCPD in patients with panic disorder
heroin high
Among the immediate effects of mainlined or snorted heroin is an intense feeling of euphoria (the rush) lasting 60 seconds or so, which many addicts compare to a sexual orgasm. However, vomiting and nausea have also been known to be part of the immediate effects of heroin and morphine use. This rush is followed by a high, during which an addict typically is in a lethargic, withdrawn state in which bodily needs, including needs for food and sex, are markedly diminished; pleasant feelings of relaxation and euphoria tend to dominate. These effects last from 4 to 6 hours and are followed—in addicts—by a negative phase that produces a desire for more of the drug.
menstruation and anorexia nervosa
An important change from DSM-IV to DSM-5 is that in DSM-5 amenorrhea (cessation of menstruation) is no longer required for a person to be given the diagnosis. Studies have suggested that women who continue to menstruate but meet all the other diagnostic criteria for anorexia nervosa are very similar psychologically to women who have amenorrhea and have ceased menstruating Amenorrhea is also not a criterion that can be used for males, nor can it be assessed in prepubescent girls or in women who use hormonal contraceptives.
LSD and flashbacks
An interesting and unusual phenomenon that may occur sometime following the use of LSD is the flashback, an involuntary recurrence of perceptual distortions or hallucinations weeks or even months after an individual has taken the drug. Flashbacks appear to be relatively rare among people who have taken LSD only once—although they do sometimes occur. Even if no flashbacks occur, one study found that continued effects on visual function were apparent at least 2 years after LSD use. In this study, Abraham and Wolf (1988) reported that individuals who had used LSD for a week had reduced visual sensitivity to light during dark adaptation and showed other visual problems compared with controls.
hypothalamus role in eating as shown in animal studies
Animal studies have demonstrated that lesions in a part of the hypothalamus called the ventromedial hypothalamus (VMH) cause the animal to behave as if starved. Such animals eat voraciously and rapidly become obese (Ravussin et al., 2014). In contrast, when the VMH is stimulated electrically, food intake is inhibited and the animal loses weight. Stimulating another area of the hypothalamus (the lateral hypothalamus) triggers eating. Animals with lesions to this area, in contrast, will stop eating.
Fiji study on ED
Anne Becker and her colleagues (2002). When Becker first began conducting research in Fiji in the 1990s, she was struck by the considerable percentage of Fijians (especially women) who were overweight with respect to their Western counterparts. From a cultural perspective, however, this made sense. Within Fijian culture, being fat was associated with qualities that were highly valued such as being strong, able to work, and kind and generous. Being thin, in contrast, was regarded negatively because it was thought to reflect being sickly, incompetent, or having somehow received poor treatment. Culturally, fatness was preferred over thinness, and dieting was viewed as offensive. What was also striking was the total absence of any condition that could be considered an eating disorder. After television came to Fiji, however, the cultural climate changed. Not only were Fijians able to see programs such as Beverly Hills 90210 and Melrose Place that were popular at that time, but many young women also began to express concerns about their weight and dislike of their bodies. For the first time, women in Fiji started to diet in earnest. The young Fijian women studied by Becker also made comments that suggested that their body dissatisfaction and wish to lose weight were motivated by a desire to emulate the actors they had seen on television.
binge-eating/purging type of anorexia
Anorexia in which the individual loses weight by bingeing and purging and also restriction
eating disorders in children
Anorexia nervosa and bulimia nervosa do not occur in appreciable numbers before adolescence. Children as young as age 7, though, have been known to develop eating disorders, especially anorexia nervosa
age of onset for various EDs
Anorexia nervosa is most likely to develop in 16- to 20-year-olds. For bulimia nervosa, the age group at highest risk is young women the age range of 21 to 24 (Zerwas et al., 2014). Most patients with binge eating disorder are older than those with anorexia nervosa or bulimia nervosa, generally between 30 and 50 years of age.
abstinence violation effect
Another type of relapse behavior involves the "abstinence violation effect," in which even minor transgressions are seen by the abstainer as having drastic significance. The effect works this way: An abstinent person may hold that she or he should not, under any circumstance, transgress or give in to the old habit. Abstinence-oriented treatment programs are particularly guided by this prohibitive rule. What happens, then, when an abstinent person becomes somewhat self-indulgent and takes a drink offered by an old friend or joins in a wedding toast? He or she may lose some of the sense of self-efficacy—confidence—needed to control his or her drinking. Feeling guilty about having technically violated the vow of abstinence, the person may rationalize that he or she "has blown it and become a drunk again, so why not go all the way?"
Which basic personality traits from the five-factor model seem most important in the development of paranoid personality disorder?
Antagonism and neuroticism
genes and BPD
BPD runs in families. In the most methodologically rigorous study to date, the risk of having a BPD diagnosis was found to be four times higher in the biological relatives of patients with BPD than it was in the relatives of people who did not have a diagnosis of BPD (Gunderson et al., 2011). Of course, we must keep in mind that just because a disorder runs in families does not invariably mean that this must be because of genes. However, in the case of BPD, we have many reasons to believe that genes are important. Indeed, they may account for 40 percent of the variance in the disorder (Amad et al., 2014). But do not take this to mean that BPD, as a disorder, is inherited. Rather, what is most likely inherited are genes that confer susceptibility to certain personality traits—traits such as neuroticism or impulsivity that are prominent aspects of BPD (Hooley et al., 2012; Paris, 2007). These inherited traits are also not specific to BPD but instead confer risk for a range of other psychopathological conditions as well. Once you appreciate this, it becomes easier to understand why BPD is so often comorbid with other disorders
dancers and anorexia
Because the artistic standards of their profession emphasize a slender physique, dancers are at especially high risk for eating disorders. This is particularly true for ballet dancers. A recent study has estimated that just under 20 percent of ballet students suffer from an eating disorder, with anorexia nervosa being the most common problem
Why are family attitudes about obesity important?
Because the consequences are likely to remain with us
BN mortality
Bulimia nervosa is much less lethal than anorexia nervosa, although it is still associated with a mortality rate that is approximately twice that found in people of comparable age in the general population
BN and suicide
Bulimia nervosa is not associated with increased risk of completed suicide, but suicide attempts are made in 25 to 30 percent of cases
beginning of Bulimia Nervosa
Bulimia typically begins with restricted eating motivated by the desire to be slender. During these early stages, the person diets and eats low-calorie foods. Over time, however, the early resolve to restrict gradually erodes, and the person starts to eat "forbidden foods" such as potato chips, pizza, cake, ice cream, and chocolate
overview: schizoid personality disorder
Characteristics: Impaired social relationships; inability and lack of desire to form attachments to others, general lack of emotion Point Prevalence in General Population: 1.2% Gender Ratio Estimate: Males > Females
overview: borderline personality disorder
Characteristics: Impulsiveness; inappropriate anger; drastic mood shifts; chronic feelings of boredom; attempts at self-mutilation or suicide Point Prevalence in General Population: 1.4% Gender Ratio Estimate: Females = Males
what is the most likely treatment for psychopathy
CBT
in-session weighing
CBT says they should see the weight
mesocorticolimbic dopamine pathway (MCLP)
Center of psychoactive drug activation in the brain. This area is involved in the release of dopamine and in mediating the rewarding properties of drugs. made of neuronal cells in the ventral tegmental area
overview: dependent personality disorder
Characteristics: Difficulty in separating in relationships; discomfort at being alone; subordination of needs in order to keep others involved in a relationship; indecisiveness Point Prevalence in General Population: 1% Gender Ratio Estimate: Females > Males
overview: obsessive-compulsive personality disorder
Characteristics: Excessive concern with order, rules, and trivial details; perfectionistic; lack of expressiveness and warmth; difficulty in relaxing and having fun Point Prevalence in General Population: 2.1% Gender Ratio Estimate: Males > Females
overview: narcissistic personality disorder
Characteristics: Grandiosity; preoccupation with receiving attention; self-promoting; lack of empathy Point Prevalence in General Population: <1% Gender Ratio Estimate: Males > Females
overview: avoidant personality disorder
Characteristics: Hypersensitivity to rejection or social derogation; shyness; insecurity in social interaction and initiating relationships Point Prevalence in General Population: 2.5% Gender Ratio Estimate: Females > Males
comorbidity and ED: personality disorders
Comorbid personality disorders are frequently diagnosed in people with eating disorders (Cassin & von Ranson, 2005; Rø et al., 2005). Indeed, about 58 percent of women with eating disorders may have a personality disorder (Rosenvinge et al., 2000). Personality disorders in the anxious-avoidant cluster (Cluster C) are found in those with anorexia nervosa as well as those with bulimia nervosa. However, dramatic, emotional, or erratic (Cluster B) problems, including borderline personality disorder, are more typically associated with bulimia nervosa (Halmi, 2010; Rosenvinge et al., 2000). Consistent with this, more than a third of patients with eating disorders have engaged in the kinds of self-harming behaviors (cutting or burning themselves, for example) that are symptomatic of borderline personality disorder (Paul et al., 2002).
comorbidity and schizoid personality disorder
Consistent with the ideas of early theorists, there is also evidence that symptoms of schizoid personality disorder do precede psychotic illness in some cases (Bolinskey et al., 2015; Hopwood & Thomas, 2012). In addition, there is some link between schizoid personality and autism spectrum disorders. This is interesting in light of recent research suggesting that schizophrenia and autism may have some common genetic basis
How does ecstasy work?
Ecstasy works primarily by triggering the release of large amounts of the neurotransmitter serotonin and blocking its reuptake, leading to feelings of euphoria, energy, and well-being (Boote, 2018). The effects of ecstasy can last for several hours. People who take the drug often report an intense experience of color and sound and mild hallucinations (de la Torre et al., 2004; Lieb et al., 2002; Soar et al., 2001) in addition to the high levels of energy and excitement that are produced.
stats and gambling disorder
Estimates place the number of pathological gamblers worldwide at between 1 and 2 percent of the adult population (Petry, 2005). Both men and women appear to be vulnerable to pathological gambling (Hing & Breen, 2001). However, rates differ by subpopulation; for example, in some high-risk populations, such as those with alcohol use disorder, the rates are higher. One study of elderly African Americans from two senior citizen centers documented the extent of gambling problems in this population; 17 percent were found to be people with gambling disorders
how do people with anorexia feel about their thinness
Even though they may look painfully thin or even emaciated, many patients with anorexia nervosa deny having any problem. Indeed, they may come to feel fulfilled by their weight loss. Despite this quiet satisfaction, however, they may feel ambivalent about their weight. Efforts are often made to conceal their thinness by wearing baggy clothes or carrying hidden bulky objects so that they will weigh more when measured by others. Patients with anorexia nervosa may even resort to drinking large amounts of water to increase their weight temporarily.
What is the most common sexual offense reported to the police in the United States, Canada, and Europe?
Exhibitionism
examples of how AN differs across cultures
For instance, about 58 percent of patients with anorexia nervosa in Hong Kong are not excessively concerned about fatness. The reason they give for refusing food is fear of stomach bloating (Lee et al., 1993). Patients with anorexia nervosa who were living in Britain but who had South Asian (Indian, Pakistani, Bangladeshi) ethnic origins also were less likely than patients with English ethnic origins to show evidence of fat phobia (Tareen et al., 2005). In yet another study, young women in Ghana who had anorexia nervosa were also not especially concerned about their weight or shape. Rather, they emphasized religious ideas of self-control and denial of hunger as the motivation for their self-starvation (Bennett et al., 2004). In a final example, Japanese women with eating disorders reported significantly lower levels of perfectionism and less of a drive for thinness than did American women with eating disorders (Pike & Mizushima, 2005).
possible goals of treatment in personality disorders
Goals might include reducing subjective distress, changing specific dysfunctional behaviors, and changing whole patterns of behavior or the entire structure of the personality
Which of the following traits associated with histrionic personality disorder are more common in men than in women?
High excitement seeking and low self-consciousness
Which basic personality traits from the five-factor model seem most important in the development of avoidant personality disorder?
High introversion and high neuroticism
assimilation and disordered eating
However, as minorities become more and more integrated and internalize white, middle-class societal values about the desirability of thinness, we should expect to see increases in the rates of eating disorders in minorities.
what is the concern about increasing the reliability of the ASPD dx
However, many researchers expressed concern that reliability was being emphasized at the expense of validity and that many key features of psychopathy were not included in the diagnostic criteria. This has raised questions about whether the ASPD construct is the same as psychopathy.
Endorphins
The human body produces its own opium-like substances, called endorphins, in the central nervous system and pituitary gland. Heroin plugs into opiate receptors (taking the place of endorphins), but works much more quickly and intensely, producing the extreme euphoria previously described
how does treatment of comorbid conditions of ppl with personality disorders go
In addition, when people have a personality disorder as well as another disorder (such as depression or an eating disorder) they tend to do less well than comparable patients without comorbid personality disorders (Crits-Christoph & Barber, 2002, 2007; Pilkonis, 2001). This is partly because people with personality disorders have rigid, ingrained personality traits that often lead to poor therapeutic relationships and additionally make them resist doing the things that would help improve their other conditions.
BN and culture
In contrast, bulimia nervosa does seem to be a culture-bound syndrome. More specifically, it seems to occur in people who have had some exposure to Western ideals about thinness, who have access to large amounts of food, and who, because of modern plumbing, can purge in private
why does alcohol intoxication differ for different people
In general, it is the amount of alcohol actually concentrated in the bodily fluids, not the amount consumed, that determines intoxication. The effects of alcohol vary for different drinkers, depending on their physical condition, the amount of food in their stomach, and the duration of their drinking. In addition, alcohol users may gradually build up a tolerance for the drug so that ever-increasing amounts may be needed to produce the desired effects. Women metabolize alcohol less effectively than men and thus become intoxicated on lesser amounts
group therapy and AUD
In some instances, the spouses of people who abuse alcohol and even their children may be invited to join in group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic efforts. Given that alcohol abuse and dependence can cause significant strains on family relationships, family therapy in such cases involves a delicate balance of educating the drinker about the familial consequences of her or his drinking, discussing any role that the family may have played in facilitating the drinking behavior (if any), and making plans for how the family can function most adaptively in the future.
big five and histronic personality disorder
In terms of the five-factor model (refer back to Table 10.2), the very high levels of extraversion of patients with histrionic personality disorder include high levels of gregariousness, excitement seeking, and positive emotions. Their high levels of neuroticism particularly involve the depression and self-consciousness facets; they are also high on openness to fantasies (
big five and BPD
In terms of the five-factor model, BPD is conceptualized as involving high neuroticism, low agreeableness, low conscientiousness, and high openness to feelings and actions
big five and narcissism
In terms of the five-factor model, both subtypes are associated with high levels of interpersonal antagonism/low agreeableness (which includes traits of low modesty, arrogance, grandiosity, and superiority), low altruism (expecting favorable treatment and exploiting others), and tough-mindedness (lack of empathy). However, the person with a more grandiose form of narcissism is exceptionally low in certain facets of neuroticism and high in extraversion. vulnerable narcissist, who has very high levels of negative affectivity/neuroticism
big five and dependent personality
In terms of the five-factor model, dependent personality disorder is associated with high levels of neuroticism and agreeableness (Lowe et al., 2009
Cluster C personality disorders
Includes avoidant, dependent, and obsessive-compulsive personality disorders. In contrast to the other two clusters, people with these disorders often show anxiety and fearfulness.
Cluster B personality disorders
Includes histrionic, narcissistic, antisocial, and borderline personality disorders. Individuals with these disorders share a tendency to be dramatic, emotional, and erratic.
distorted values in people with anorexia
Indicative of the distorted values of patients with eating disorders (see Table 9.1 for personal comments that provide examples of this), those with the restricting type of anorexia nervosa are often greatly admired by others with eating disorders. One patient reported that she had not been "successful" in her anorexia nervosa because of her failure to reach an extremely low weight. Her belief was that the hallmark of a truly successful person with anorexia nervosa was death from starvation, and that patients who were able to accomplish this should somehow be revered
research on treatment of AN
Individuals with anorexia nervosa view the disorder as a chronic condition and are generally pessimistic about their potential for recovery (Holliday et al., 2005). They have a high dropout rate from therapy, and patients with the binge-eating/purging subtype of anorexia nervosa are especially likely to terminate inpatient treatment prematurely (Steinhausen, 2002; Woodside et al., 2004). Making the situation even worse, there have been surprisingly few controlled studies on which to base an informed judgment about which treatment modality will work best (le Grange & Lock, 2005; Wilson, Grilo, & Vitousek, 2007). In part, this is due to the fact that the disorder is rare. However, patients who suffer from anorexia nervosa are also often extremely reluctant to seek treatment. And when they do, taking part in research studies is unlikely to be a priority for them. These factors combine to make treatment research extremely difficult.
why are personality disorders misdx
One problem is that diagnostic criteria for personality disorders are not as sharply defined as they are for most other diagnostic categories Because the criteria for personality disorders are defined by inferred traits or consistent patterns of behavior rather than by more objective behavioral standards (such as having a panic attack or a prolonged and persistent depressed mood), the clinician must exercise more judgment in making the diagnosis than is the case for many other disorders.
five factor model and schizotypal personality disorder
Interestingly, although some aspects of schizotypy appear related to the five-factor model of normal personality (specifically facets of introversion and neuroticism), the other aspects related to cognitive and perceptual distortions are not adequately explained by the five-factor model of normal personality (Watson et al., 2008). Indeed, these core symptoms of schizotypy form the basis of the only proposed trait that does not map neatly onto the five factors of normal personality. This pathological trait is psychoticism, which consists of three facets: unusual beliefs and experiences, eccentricity, and cognitive and perceptual dysregulation (Krueger, Eaton, Derringer, et al., 2011)
view of body in BED
Interestingly, individuals with binge-eating disorder are more likely to have overvalued ideas about the importance of weight and shape than patients who are overweight or obese and who do not have BED.
Which of the following has been indicated as the best approach in the treatment of binge eating disorder?
Interpersonal psychotherapy
cocaine history
It was widely used in the pre-Columbian world of Mexico and Peru, where leaves of the coca plant were wrapped around lime and placed inside the cheek to provide a slow release—allowing workers to decrease their hunger and elevate their mood and energy so they could work long hours (Guerra, 1971). Cocaine later gained popularity in the 1880s when Sigmund Freud came to see it as a wonderful treatment for depression, indigestion, and a range of other maladies. Arthur Conan Doyle described how his fictional character—Sherlock Holmes—enjoyed the drug, and entrepreneur John Pemberton included it as a key ingredient in his new soft drink: Coca-ColaTM
long term follow up with ppl with AN
Löwe and colleagues (2001) examined what happened to patients with anorexia nervosa 21 years after they had first sought treatment. Reflecting the high morbidity associated with anorexia nervosa, 16 percent of the patients (all of whom were women) were no longer alive, having died primarily from complications of starvation or from suicide. Another 10 percent were still suffering from the disorder, and a further 21 percent had partially recovered. On the positive side, however, 51 percent of the individuals were fully recovered at the time of the follow-up.
ecstasy aka
MDMA
hashish
Marijuana is related to a stronger drug, hashish, which is derived from the resin exuded by the cannabis plant and made into a gummy powder. Hashish, like marijuana, is usually smoked.
MI and AUD
Motivational interviewing (MI) is a brief intervention that was designed to be a major departure from earlier confrontational approaches in which a clinician suggested that the drinker stop consuming so much alcohol. Instead, in MI the clinician guides the patient through a collaborative conversation in which the patient articulates the pros and cons of drinking and ultimately makes a decision about whether she or he is motivated to change (Miller & Rollnick, 2012). A great strength of MI is that it can be administered in one brief (35-minute) session and still have positive effects. For instance, a recent study found that adolescents visiting an emergency department (ED) with alcohol problems and aggression who were randomly assigned to receive a brief MI-focused intervention via a clinician or computer (compared to those who received no such intervention) showed significant reductions in their drinking and aggression up to 6 months after this brief intervention
Which of the following personality disorders is more common in Western cultures?
Narcissistic
dopamine theory of addiction
Not all drugs work by binding to opiate receptors; however, there does seem to be a common pathway for all addictions, both drug (e.g., alcohol, opiates, cocaine) and nondrug (e.g., gambling) related. The dopamine theory of addiction suggests that addiction is the result of a dysfunction of the dopamine reward pathway (Diana, 2011). This pathway, also called the "pleasure pathway," as mentioned earlier in our discussion of alcohol addiction, was first discovered in seminal work by Olds and Milner (1954), who found that rats would repeatedly press a lever to self-stimulate certain areas of their brain (via electrodes placed there) instead of engaging in any other activity.
possible subtypes of narcissistic personality disorder
Numerous studies support the notion of two subtypes of narcissism: grandiose and vulnerable narcissism (Cain et al., 2008; Ronningstam, 2012). The grandiose presentation of narcissism, highlighted in the DSM-5 criteria, is manifested by traits related to extreme grandiosity, aggression, and dominance. The vulnerable presentation of narcissism is not as clearly reflected in the DSM criteria but nevertheless represents a subtype long observed by researchers and clinicians. Vulnerable narcissists have a very fragile and unstable sense of self-esteem, and for these individuals, arrogance and condescension is merely a façade for intense shame and hypersensitivity to rejection and criticism
goals of DBT
One of the primary goals of treatment is to encourage patients to accept this negative affect without engaging in self-destructive or other maladaptive behaviors. Accordingly, Linehan has developed a problem-focused treatment based on a clear hierarchy of goals, which prioritizes decreasing suicidal and self-injurious behavior and increasing coping skills.
race and AUD
There do not seem to be important differences in rates of alcohol abuse between black and white Americans, although Native Americans tend to have higher rates of alcohol abuse, and Asian Americans tend to have lower usage.
brain and psychopathy
Other differences in brain structure and function have also been reported. Deficits in the prefrontal cortex (which is involved in behavioral control and decision making) as well as the amygdala (which is a key brain area for emotion and fear conditioning) are thought to play a role in some of the behavioral and emotional disturbances linked to psychopathy (Kiehl, 2006; Yang & Raine, 2009). Unsuccessful psychopaths, however, seem to have more pronounced defects in these areas than successful psychopaths or healthy controls (Yang et al., 2010).
overview of treatment for AUD
Overall, less than one-third of those with alcohol use disorders receive treatment, and available treatments for alcohol-related disorders show modest effects (Hasin et al., 2007; Magill & Ray, 2009). In general, a multidisciplinary approach to the treatment of drinking problems appears to be most effective because the problems are often complex, requiring flexibility and individualization of treatment procedures (Margolis & Zweben, 1998). Also, a substance abuser's needs change as treatment progresses. Treatment objectives usually include detoxification, physical rehabilitation, control over alcohol abuse behavior, and the individual's realizing that he or she can cope with the problems of living and lead a much more rewarding life without alcohol.
help seeking in ED
Patients with eating disorders are often very conflicted about getting well. Approximately 17 percent of patients with severe eating disorders have to be committed to a hospital for treatment against their will (Watson, Bowers, & Andersen, 2000). Suicide attempts are often made, and clinicians need to be mindful of this risk, even when patients have received a great deal of treatment
Which of the following comments is indicative of a gambling disorder? Paxton states, "I've tried about six times to just stop gambling, or to stay away from the off-track betting, but I love those ponies!" Marcy says to her mother, "I only play blackjack when I'm in one of my euphoric manic phases, and I usually have great luck!"
Paxton states, "I've tried about six times to just stop gambling, or to stay away from the off-track betting, but I love those ponies
personality disorders and other people
People with personality disorders often cause at least as much difficulty in the lives of others as they do in their own lives. Other people tend to find the behavior of individuals with personality disorders confusing, exasperating, unpredictable, and, to varying degrees, unacceptable
Which of the following is a symptom of male hypoactive sexual desire disorder?
Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity for at least six months
what do personality disorders stem from
Personality disorders typically do not stem from debilitating reactions to stress in the recent past, as does posttraumatic stress disorder (PTSD) or many cases of major depression. Rather, these disorders come largely from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, and relating to the world. Nonetheless, stressful events early in life may help set the stage for the development of these inflexible and distorted personality patterns.
overall cause of BPD
So how can we best understand the causes of BPD? At the present time, it is reasonable to suggest that some people, by virtue of their genetic predispositions, may be highly sensitive to the effects of negative early life experiences. These stressful early experiences may create long-term dysregulation of the HPA axis (which you learned about in Chapter 5) and shape brain development, perhaps compromising key brain circuits that are involved in emotion regulation
what children are at a high risk of ASPD and high scores on the antisocial dimension of psychpathy
Some children have great difficulty learning to regulate their emotions and show high levels of emotional reactivity, including aggressive and antisocial behaviors when responding to stressful demands and negative emotions like frustration and anger
BN medical complications
Purging can cause electrolyte imbalances and low potassium, which, as we have already mentioned, puts the patient at risk for heart abnormalities. Another complication is damage to the heart muscle, which may be due to the use of ipecac syrup, a poison that causes vomiting. More typically, however, patients develop calluses on their hands from sticking their fingers down their throats to make themselves sick. In extreme cases, where objects such as a toothbrush are used to induce vomiting, tears to the throat can occur. Because the contents of the stomach are acidic, patients damage their teeth when they throw up repeatedly. Brushing the teeth immediately after vomiting damages them even more. Mouth ulcers and dental cavities are a common consequence of repeated purging, as are small red dots around the eyes that are caused by the pressure of throwing up. Finally, patients with bulimia very often have swollen parotid (salivary) glands caused by repeatedly vomiting. These are known as "puffy cheeks" or "chipmunk cheeks" by many people with bulimia. Although such swellings are not painful, they are often quite noticeable to others.
Which of the following is an accurate statement about crack cocaine use?
Research suggests that there is no fetal crack syndrome.
therapeutic use of LSD
Researchers believed LSD might be useful for the induction and study of hallucinogenic states or "model psychoses," which were thought to be related to schizophrenia. About 1950, LSD was introduced into the United States for the purposes of such research and to ascertain whether it might have medical or therapeutic uses. Despite considerable research, however, LSD did not prove to be therapeutically useful.
brain areas involved in EDs
damage to the frontal and the temporal cortex did seem to be linked to the development of anorexia nervosa in some cases and bulimia nervosa in others. This is interesting because the temporal cortex is known to be involved in body image perception. Parts of the frontal cortex (particularly an area called the orbitofrontal cortex) also play a role in monitoring the pleasantness of stimuli such as smell and taste
Which of the following is a common component of cognitive behavioral treatments for antisocial personality?
Self-critical thinking
tryptophan and ED
Serotonin is made from an essential amino acid called tryptophan. This can only be obtained from food. After tryptophan is consumed, it is converted to serotonin via a series of chemical reactions. People with anorexia nervosa have low levels of 5-HIAA, which is a major metabolite of serotonin. This may be because they are eating so little food. In contrast, levels of 5-HIAA are normal in people with bulimia nervosa. What is interesting is that, after recovery, both of these patient groups have higher levels of 5-HIAA than control women do; they also have higher levels of 5-HIAA than they had when they were in the ill state (Kaye, 2008). Although the finding of higher levels of 5-HIAA in recovered patients compared to controls seems counterintuitive, it has been suggested that resuming normal eating makes it possible to detect abnormalities in the serotonin system (such as higher levels of serotonin in several different brain areas) that might be involved in risk for eating disorders. Kaye and colleagues have further suggested that people with serotonin overactivity may use dieting as a way to regulate this by decreasing the amount of tryptophan that is available to make serotonin
psychosis and alcohol use
Several acute psychotic reactions fit the diagnostic classification of substance-induced disorders. These reactions may develop in people who have been drinking excessively over long periods of time. Such acute reactions usually last only a short time and generally consist of confusion, excitement, and delirium. These disorders are often called alcohol-induced psychotic disorders because they are marked by a temporary loss of contact with reality
shifts btwn AN and BN
Shifts from anorexia nervosa to bulimia nervosa also occurred in about a third of patients. Interestingly, however, there were no cases of direct transition from the restricting type of anorexia nervosa directly into bulimia nervosa. Instead, the transition to bulimia nervosa seems to occur after an earlier transition to the binge-eating/purging subtype of anorexia nervosa. Only a minority of patients with bulimia nervosa transition into anorexia nervosa
mainlining vs skin popping
Skin popping is injecting the liquefied drug just beneath the skin, while mainlining is injecting the drug directly into the bloodstream.
dependent personality vs BPD and histrionic and avoidant
Some of this comorbidity may stem from overlap between the features of dependent personality disorder and those of borderline, histrionic, and avoidant personality disorders. However, at the clinical level, there are key differences as well (refer back to Table 10.2). For example, both borderline personalities and dependent personalities fear abandonment. However, the borderline personality, who usually has intense and stormy relationships, reacts with feelings of emptiness or rage if abandonment occurs, whereas the dependent personality reacts initially with submissiveness and appeasement and then finally with an urgent seeking of a new relationship. Histrionic and dependent personalities both have strong needs for reassurance and approval, but the histrionic personality is much more gregarious, flamboyant, and actively demanding of attention, whereas the dependent personality is more docile and self-effacing. It can also be hard to distinguish between dependent and avoidant personalities. As noted, dependent personalities have great difficulty separating in relationships because they feel incompetent on their own and have a need to be taken care of, whereas avoidant personalities have trouble initiating relationships because they fear the humiliation they will experience if they are criticized or rejected (Millon & Martinez, 1995). Even so, we should remember that avoidant personality co-occurs with dependent personality disorder rather frequently (Arntz et al., 2009; Bernstein & Travaglini, 1999; Bornstein et al., 2015). This fits with the observation that people with avoidant personality disorder do not avoid absolutely everyone and that their dependent personality disorder characteristics are focused on the one or few individuals whom they do not avoid
substance abuse vs dependence
Substance abuse generally involves an excessive use of a substance resulting in (1) potentially hazardous behavior such as driving while intoxicated or (2) continued use despite a persistent social, psychological, occupational, or health problem. Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing amounts of a substance to achieve the desired effects. Dependence in these disorders means that an individual will show a tolerance for a drug and/or experience withdrawal symptoms when the drug is unavailable.
causal factors in psychopathy
The causes of psychopathy are complex and involve many factors. Genetics, temperamental characteristics, deficiencies in fear and anxiety, more general emotional deficits, hypersensitivity to reward, the early learning of antisocial behavior as a coping style, as well as particular family and environmental factors are thought to be involved.
binge-eating/purging type of anorexia VS bulimia nervosa
The clinical picture of the binge-eating/purging type of anorexia nervosa has much in common with bulimia nervosa. Indeed, some researchers have argued that the bulimic type of anorexia nervosa should really be considered another form of bulimia nervosa. The difference between a person with bulimia nervosa and a person with the binge-eating/purging type of anorexia nervosa is weight.
length of alcohol withdrawal delirium and risk
The delirium typically lasts from 3 to 6 days and is generally followed by a deep sleep. When a person awakens, few symptoms remain, but frequently the individual is scared and may not resume drinking for several weeks or months. It has been estimated that approximately 30 percent of patients with alcohol withdrawal delirium die within 8 years of onset, though risk of death is significantly decreased with appropriate treatment (Mainerova et al., 2015). Drugs such as chlordiazepoxide (Librium), however, have demonstrated the ability to decrease withdrawal symptoms and with it the risk of death as a result of withdrawal
what aids in reliability of personality disorder dx
The development of semi-structured interviews and self-report inventories for the diagnosis of personality disorders has improved diagnostic reliability substantially. However, because agreement between the diagnoses made on the basis of different interviews or self-report inventories is often rather low, problems still remain with the reliability and validity of these diagnoses
history of amphetamine
The earliest amphetamine to be introduced—Benzedrine, or amphetamine sulfate—was first synthesized in 1927 and became available in drugstores in the early 1930s as an inhalant to relieve stuffy noses. However, the manufacturers soon learned that some customers were chewing the wicks in the inhalers for "kicks." Thus, the stimulating effects of amphetamine sulfate were discovered by the public before the drug was formally prescribed as a stimulant by physicians. In the late 1930s, two newer amphetamines were introduced: Dexedrine (dextroamphetamine) and Methedrine (methamphetamine hydrochloride, also known as "speed"). The latter preparation is a far more potent stimulant of the CNS than either Benzedrine or Dexedrine and hence is considered more dangerous. In fact, its abuse can be lethal.
two important factors involved in the power that substances have
The first is the ability of most, if not all, addictive substances to activate areas of the brain that produce intrinsic pleasure and sometimes immediate, powerful reward. The second factor involves the person's biological makeup, or constitution, including his or her genetic inheritance and the environmental influences (learning factors) that enter into the need to seek mind-altering substances to an increasing degree as use continue
soldier's illness
The hypodermic needle was introduced in America around 1856, allowing morphine to be widely administered to soldiers during the Civil War—not only to those wounded in battle but also to those suffering from dysentery (an illness with symptoms including abdominal pain and diarrhea with blood). As a consequence, many Civil War veterans returned to civilian life addicted to the drug, a condition euphemistically referred to as "soldier's illness."
overview of treatment for BN
The leading treatment for bulimia nervosa is CBT. Most of the current treatment approaches are based on the work of Fairburn and colleagues in Oxford, England. Antidepressant medications are also used, either alone or in combination with CBT
process leading to relapse
The longer the person is able to maintain this control, the greater the sense of achievement—the self-efficacy or confidence—and the greater the chance that she or he will be able to cope with the addiction and maintain control. However, a person may violate this rule of abstinence through a gradual, perhaps unconscious, process rather than through the sudden "falling off the wagon" that constitutes the traditional view of craving and relapse. In the cognitive-behavioral view, a person may, even while maintaining abstinence, inadvertently make a series of mini-decisions that begin a chain of behaviors that render relapse inevitable. For example, an abstinent alcohol abuser who buys a quart of bourbon just in case his friends drop by is unconsciously preparing the way for relapse.
mortality with AN
The mortality rate for people with anorexia nervosa (most of whom are females) is more than five times higher than the mortality rate for young females ages 15 to 34 in the general U.S. population When patients with this disorder die, it is most often because of medical complications. Overall, approximately 3 percent of people with anorexia nervosa die from the consequences of their illness
suicide and AN
The most recent estimate from a meta-analysis suggests that individuals with anorexia nervosa are 18 times more likely to die by suicide than comparably aged women in the general population (Keshaviah et al., 2014). It has been suggested that patients who have lost their ability to maintain an "emotionally protective" low body weight are at particularly high risk of suicide (Crisp et al., 2006). Chronic starvation may habituate patients to painful experiences, increasing their risk of self-injury and suicide (Joiner, 2005). Patients who are older when they first receive clinical attention for their disorder are also more likely to have a premature death (Arcelus et al., 2011).
prevalence of psychopathy and gender
The prevalence of psychopathy is unknown because no epidemiological studies have assessed this. However, for males in North America, the prevalence is estimated to be about 1 to 2 percent (Patrick & Drislane, 2015). Rates for women are estimated to be much lower (well under 1 percent).
research on AA
The reported success of Alcoholics Anonymous is based primarily on anecdotal information rather than on objective study of treatment outcomes because AA does not directly participate in external comparative research efforts. There have been studies focused on testing the effectiveness of AA, but these have been largely inconclusive due to methodological concerns.
risk of developing EDs throughout time
The risk of developing anorexia nervosa seemed to increase during the twentieth century. In one study, lifetime rates of this disorder were higher in people born after 1945 than before this time (Klump et al., 2007). This is true for both males and females. This increase is not fully explained by increased awareness of the disorder and better detection by clinicians. There was also a rise in the number of new cases of bulimia nervosa from 1970 to 1993 (Keel & Klump, 2003). However, much of this increase may have occurred in the time period up to 1982. A more recent analysis has indicated that the prevalence of bulimia nervosa decreased from 1982 to 1992 and remained stable from 1992 to 2002 (Keel et al., 2006). Stable rates of bulimia nervosa from 1990 to 2004 have also been reported (Crowther et al., 2008).
history of BPD
The term borderline personality has a long and rather confusing history (Hooley et al., 2012). Originally it was used to refer to patients who were very challenging to deal with and who were thought to have a condition that was on the "border" between neurosis and psychosis. Later, the word was used to describe patients who had some features of schizophrenia (as in borderline schizophrenia). By 1980, however, the key clinical aspects of borderline personality disorder (BPD) had been clarified sufficiently to permit entry into the DSM as a distinct diagnosis.
evidence based therapy for ed
dbt fbt family based (bd an) ipt cbt antidepressants
set point
There is a well-established tendency for our bodies to resist marked variation from some sort of biologically determined set point or weight that our individual bodies try to "defend" (Garner, 1997; Ravussin et al., 2014). Anyone intent on achieving and maintaining a significant decrease in body mass below his or her individual set point may be trying to do this in the face of internal physiological opposition, which is aimed at trying to get the body back close to its original set-point weight.
reward brain areas in AN
There is also evidence that patients with anorexia nervosa show more activity in brain reward areas when they view pictures of thin rather than healthy models. For controls, the opposite pattern is found with more reward area activity occurring when viewing normal weight models.
EDs and the hypothalamus
There is no good evidence that obvious abnormalities in the hypothalamus play a central role in eating disorders, however. Uher and Treasure (2005) reviewed a series of case reports of patients with tumors in the hypothalamus. Although these were sometimes associated with an increase or loss of appetite, there was no evidence that they resulted in specific eating disorders.
very general overview of causes of EDs
There is no single cause of eating disorders. In all probability, they reflect the complex interaction between genetic and environmental factors. Biological, sociocultural, family, and individual variables likely all play a role. However, it is important not to regard these areas as distinct and in competition with each other. The question of whether eating disorders are caused by biological factors or by cultural pressures is not an appropriate one. Biological and cultural explanations are interlinked.
dimensional approach to personality dx
This assumes that personality (and personality disorder) is on a continuum. Accordingly, researchers have tried to develop dimensional systems of assessment for the symptoms and traits involved in personality disorders (e.g., Clark, 2007; Krueger & Eaton, 2010; Trull & Durrett, 2005; Widiger et al., 2009). However, a unified dimensional classification of personality disorders has been slow to emerge, and the focus is now on developing an approach that will integrate the many different existing approaches Within a dimensional approach, normal personality trait dimensions can be recast into corresponding domains that represent more pathological extremes of these dimensions: negative affectivity (neuroticism); detachment (extreme introversion); antagonism (extremely low agreeableness); and disinhibition (extremely low conscientiousness). A fifth dimension, psychoticism, does not appear to be a pathological extreme of the final dimension of normal personality (openness)—rather, as we will discuss later in the chapter in the section on schizotypal personality disorder, it reflects traits similar to the symptoms of psychotic disorders
why should anorexia and bulimia be seperate
This is because there is a far greater mortality rate associated with anorexia nervosa than with bulimia nervosa. Recognizing this, the DSM requires that the more severe form of eating pathology take precedence diagnostically.
when can treatment make psychopathy worse
This may be especially likely to occur if the treatment program emphasizes training in social skills or empathy because such skills may simply make them better at charming or conning future victims
In which of the following countries are at least one-third of adults obese?
US
Harrison Act
Under this and later legislation, the unauthorized sale and distribution of certain drugs became a federal offense; physicians and pharmacists were held accountable for each dose they dispensed Thus, overnight, the role of a chronic narcotic user changed from that of addict—whose addiction was considered a vice, but was tolerated—to that of criminal.
Diagnostic crossover of eating disorders
What this means is that it is quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. This may reflect the fact that current diagnostic systems are not doing a good job categorizing these disorders and that dimensionally based approaches might be more appropriate. Bidirectional transitions between the two subtypes of anorexia nervosa (restricting and binge-eating/purging) were especially common.
view of their disorder: bulimia vs anorexia
Whereas people with anorexia nervosa often deny the seriousness of their disorder and are surprised by the shock and concern with which others view their emaciated conditions, those with bulimia nervosa are often preoccupied with shame, guilt, and self-deprecation. They make efforts to conceal their behavior as they struggle (often unsuccessfully) to master their urges to binge. The case described next depicts a typical pattern.
childhood and BPD
With regard to the latter, child maltreatment and other extreme early life experiences have long been linked to BPD. Importantly, two prospective community-based studies have shown that childhood adversity and maltreatment increases the risk of developing BPD in adulthood Overall, about 90 percent of patients with BPD reported some type of childhood abuse or neglect.
heroin withdrawal
Withdrawal from heroin is not always dangerous or even very painful. Many addicted people withdraw without assistance. Withdrawal can, however, be an agonizing experience for some people, with symptoms including runny nose, tearing eyes, perspiration, restlessness, increased respiration rate, and an intensified desire for the drug. As time passes, the symptoms may become more severe. Withdrawal symptoms usually decline by the third or fourth day and by the seventh or eighth day have disappeared.
prevalence of bulimia and anorexia
Worldwide, the prevalence of bulimia nervosa is estimated at 1 percent (Kessler et al., 2013). Data from the National Comorbidity Survey further show that the lifetime prevalence of bulimia nervosa in the United States is around 1.5 percent for women and 0.5 percent for men (Hudson et al., 2007). Somewhat less frequent is anorexia nervosa. Estimates from the United States suggest that this disorder has a lifetime prevalence of 0.9 percent in women and 0.3 percent in men
why do ASPD and psychopathy not directly map onto one another
You should also note that, with their strong emphasis on behavioral criteria that can be measured reasonably objectively, the features of DSM-5 antisocial personality disorder do not fully map onto the construct of psychopathy as originally described. This was done deliberately in an attempt to increase the reliability of the ASPD diagnosis
Disulfiram (Antabuse)
a drug that causes violent vomiting when followed by ingestion of alcohol, may be administered to prevent an immediate return to drinking (Grossman & Ruiz, 2004). However, such deterrent therapy is seldom advocated as the sole approach because an alcohol-dependent person may simply discontinue the use of Antabuse when he or she is released from a hospital or clinic and begins to drink again.
ventral tegmental area
a group of dopamine-containing neurons located in the midbrain whose axons project to the forebrain, especially the nucleus accumbens and cortex
Dialectical behavior therapy is ________
a promising, problem-focused treatment for borderline personality disorder.
Lanugo is?
a soft hair that grows on the body of people with anorexia.
The finding that temperament may play a role in the etiology of personality disorders suggests that ________
a susceptibility to the development of a personality disorder may be inherited
amenorrhea
absence of menstruation
when can the features of a personality disorder be recognized
adolescence or early adulthood
central characteristics of BPD
affective instability highly unstable self-image fear of abandonment impulsivity cutting
alcohol withdrawal delirium
aka DTs (1) disorientation for time and place, in which, for example, a person may mistake the hospital for a church or jail, no longer recognize friends, or identify hospital attendants as old acquaintances; (2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches; (3) acute fear, in which these animals may change in form, size, or color in terrifying ways; (4) extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested; (5) marked tremors of the hands, tongue, and lips; and (6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue, and foul breath.
why might someone be anxious during hangover
alcohol consumption leads to the suppression of glutamate, a major excitatory neurotransmitter, which contributes to the feeling of calmness during intoxication. However, after a person stops drinking, the body makes up for lost time by producing a lot of glutamate, which can lead to trouble with sleeping and with increased jitters and anxiety the next da
alcohol-induced psychotic disorders
alcohol withdrawal delirium alcohol amnestic disorder
who gets addicted to barbiturates
although many young people experiment with barbiturates, most do not become dependent. In fact, the individuals who do become dependent on barbiturates tend to be middle-aged and older people who often rely on them as "sleeping pills" and who do not commonly use other classes of drugs
BED treatments
at 2-year follow-up, people who had received either IPT or guided CBT were doing better than those in the behavioral weight loss group. What is also noteworthy is that the dropout rate was much lower for people in the IPT group (7 percent dropped out) than it was in the guided CBT (30 percent) or behavioral weight loss groups (28 percent). This is important because, overall, the dropout rate for minorities in this study was very high (approximately one-third). The findings therefore suggest that for racial and ethnic minorities with BED, interpersonal psychotherapy might be a particularly suitable treatment approach.
The first phase of the human sexual response is __________.
desire
Charles Lasègue in Paris and Sir William Gull in London
both separately named anorexia
The most common form of incest is between ________
brother/sister
There is a general agreement among researchers that personality ________
can be characterized by five basic trait dimensions.
Opium and its derivatives __________.
cause withdrawal symptoms in addicts within approximately eight hours of the last dose
bulimia nervosa
characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise. Bulimia nervosa was recognized as a psychiatric syndrome relatively recently. The British psychiatrist G. F. M. Russell (1997) proposed the term in 1979, and it was adopted into the DSM in 1987
heroin discovery
cientists concerned with the addictive properties of morphine hypothesized that one part of the morphine molecule might be responsible for its analgesic properties (that is, its ability to eliminate pain without a loss of consciousness) and another for its addictiveness. At about the turn of the century, it was discovered that if morphine was treated with an inexpensive and readily available chemical called acetic anhydride, it would be converted into another powerful analgesic called heroin
relapse prevention treatment
clients are taught to recognize the apparently irrelevant decisions that serve as early warning signals of the possibility of relapse.
stimulants
cocaine and amphetamines
comorbidity and ED: general, depression, OCD, SUD
comorbidity is the rule rather than the exception (Hudson et al., 2007). For instance, approximately 68 percent of patients with anorexia nervosa, 63 percent of patients with bulimia nervosa, and almost 50 percent of people with binge-eating disorder are also diagnosed with depression (Brewerton et al., 1995; Halmi, et al., 1991; Hudson et al., 2007; O'Brien & Vincent, 2003). Obsessive-compulsive disorder is often found in patients with anorexia nervosa and bulimia nervosa (Kaye et al., 2004; Milos et al., 2002; O'Brien & Vincent, 2003). In addition, there is frequent co-occurrence of substance abuse disorders in the binge-eating/purging subtype of anorexia nervosa as well as in bulimia nervosa. The restrictive type of anorexia nervosa, however, tends not to be associated with higher rates of substance abuse (Halmi, 2010).
heavy episodic drinking
consumption of six or more alcoholic drinks on at least one occasion at least once per month
how does AN differ across cultures but is still considered to not be culturally bound?
culture may influence the disorder's clinical manifestation. The more important point, however, is that anorexia nervosa is not a disorder that occurs simply because of exposure to Western ideals and the modern emphasis on thinness.
pathological gambling
does not involve a chemically addictive substance, it is considered by many to be an addictive disorder because of the personality factors that tend to characterize compulsive gamblers (Petry & Madden, 2010). Like the substance abuse disorders, pathological gambling involves behavior maintained by short-term gains despite long-term disruption of an individual's life. There is a high comorbidity between pathological gambling and alcohol use disorders (Blanco et al., 2010) and with personality disorders
at what point is a personality disorder diagnosed
enduring pattern of behavior or inner experience that is pervasive and inflexible, stable across time, and of long duration. It must also cause either clinically significant distress or impairment in functioning and be manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.
big five and OCPD
excessively high levels of conscientiousness (Samuel & Widiger, 2011). This leads to extreme devotion to work, perfectionism, and excessive controlling behavior. They are also high on assertiveness (a facet of extraversion) and low on compliance (a facet of agreeableness).
Naltrexone and Acamprosate
naltrexone, an opiate antagonist that helps reduce the craving for alcohol by blocking the pleasure-producing effects of alcohol, and acamprosate, a drug whose properties are still being studied (Gueorguieva et al., 2007; Lee et al., 2010). A recent large-scale review of 122 randomized controlled trials testing the effects of medications for alcohol use disorders found that both naltrexone and acamprosate are effective at decreasing drinking and heavy drinking (Jonas et al., 2014).
schizoid personality disorder and the big five
extremely high levels of introversion (especially low on warmth, gregariousness, and positive emotions). They are also low on openness to feelings (one facet of openness to experience) and on achievement striving
who does the ASPD fail to include that psychopathy would
fails to include people who show many of the features of the affective and interpersonal dimensions of psychopathy but not as many features of the lifestyle and antisocial dimensions, or at least few enough that these individuals do not generally get into trouble with the law. This group might include, for example, unprincipled and predatory business or financial professionals, manipulative lawyers, high-pressure evangelists, and crooked politicians
best treatment for adolescents with AN
family therapy
most prevalent and stable features of avoidant personalitiy
feeling inept and socially inadequate
Lanugo
fine, downy, unpigmented hair covers AN
Regarding different cross-cultural manifestations of psychopathy, one of the primary symptoms where cultural variations occur is
frequency of aggressive and violent behavior because socialization has a large impact on this
risk factor for ED in men
gay/bi gay men tended to believe that a potential mate would want them to be leaner than they themselves wanted to be.
other than stereotypes, why are men less likely to be dx with ED
gender bias in the DSM criteria. These emphasize the type of weight and shape concerns (e.g., desire to be thin) and methods of weight control (dieting) that are more typical of women. For men, body dissatisfaction often involves a wish to be more muscular. Overexercising as a means of weight control is also more common in men
mescaline
natural hallucinogen derived from the peyote cactus buttons
Psilocybin
natural hallucinogen found in certain mushrooms
what risk factors for eating disorders
genetics - not eating related but moreso perfectionism etc gender - might be bio, 3x sex abuse diets media social pressure body dissatisfaction important thin neg affect perfectionism
what occurs when you do tdcs of the MCLP
great pleasure and has strong reinforcing properties
has certain personality disorders increased in american society recently
has also been suggested that known increases over the 70 years since World War II in emotional dysregulation (e.g., depression, self-injurious behavior, and suicide) and impulsive behaviors (substance abuse and criminal behavior) may be related to increases in the prevalence of borderline and ASPDs over the same time period. This could stem from increased breakdown of the family and other traditional social structures (Paris, 2001, 2007) and may vary across cultures depending on whether similar breakdowns have occurred.
Misdiagnosis of Personality Disorders
higher than any other category of disorder
meth
highly addictive stimulant drug that can provide an immediate and long-lasting "high." However, it is one of the most dangerous illegal drugs (Covey, 2007). Methamphetamine is a form of amphetamine that can be "cooked" in large quantities in makeshift laboratories (e.g., within people's own homes). It can be manufactured, for example, in a portable cooler with ingredients that can be legally obtained from any drugstore. This drug is relatively cheap to make and is sometimes referred to as "poor people's cocaine." Like cocaine and heroin, it can be ingested in a variety of ways, through smoking, snorting, swallowing, or injecting.
reward deficiency syndrome
hypothesis suggests that addiction is much more likely to occur in individuals who have genetic deviations in components of the reward pathway, which leads them to be less satisfied by natural rewards (e.g., from food, sex, drugs, and other pleasurable activities), which in turn leads them to overuse drugs and related experiences as a way to adequately stimulate their reward pathway
fear and psychopaths
impaired fear conditioning
Gastric bypass surgery makes it ________
impossible to binge eat but still possible to regain weight.
major characteristics of psychopaths
inadequate conscience development irresponsible and impulsive behavior ability to impress and exploit others
ideas for what could predispose a person to get a personality disorder
infants' temperament due to this, it's component features are heritable maladaptive cognitive styles (may come from attachment) maladaptive habits (may come from attachment) early abuse
The McMartin Preschool case demonstrates how __________.
interviewing style can alter the nature of a child's testimony
DSM-5 Pedophilic Disorder
is defined by the age of the preferred partner.
According to Barlow and colleagues, the role of anxiety in erectile dysfunction __________.
is less important than the distraction of thinking about it.
Barbiturate withdrawal ________
is more dangerous and long-lasting than opiate withdrawal.
speculative relationship btwn EDs and hypothalamus
it is reasonable to suggest that the hypothalamus "senses" weight in some way and keeps things in balance with the ventromedial hypothalamus acting as a "satiety center" and the lateral hypothalamus serving as an "appetite center." It is also reasonable to think that the lateral hypothalamus acts as a site that integrates other information relevant for regulating food intake. The lateral hypothalamus receives information from many parts of the brain, including the frontal cortex and the amygdala (which is a part of the brain involved in emotion and fear learning). Animal research suggests that a network involving these (and other) brain areas may be important not only for overeating in response to environmental cues but for suppressing eating in response to fear (Petrovich, 2011).
The weight-loss drug sibutramine (Meridia) has been in use for many years. Recently ________
it was withdrawn from the market due to safety concerns.
Treatment of Schizotypal Personality Disorder
low doses of antipsychotic drugs (including the newer, atypical antipsychotics; e.g., Keshavan et al., 2004; Koenigsberg et al., 2007; Raine, 2006) may result in modest improvements. Antidepressants from the SSRI category may also be useful. However, no treatment has yet produced anything approaching a cure for most people with this disorder
psychopaths and emotion
low on anxiety, empathy, fear
Rates of alcoholism among Asian populations are ________ than among European peoples. This fact may be related to ________.
lower; a mutant enzyme that leads to hypersensitive reactions to alcohol
endocannabinoid system
major regulator of appetite and feeding
what children are likely to develop psychopathy with low fear and lack of empathy
may have few problems regulating negative emotions, instead showing fearlessness and low anxiety as well as callous/unemotional traits and reduced amygdala activation while responding to fearful facial expressions (e.g., Marsh et al., 2008). These are the children most likely to show poor development of conscience, and their aggressive behaviors are more instrumental and premeditated rather than reactive as seen with those children who have emotional regulation difficulties
Malnutrition ________
may occur in alcoholics since alcohol interferes with the body's ability to use nutrients.
opium
mixture of about 18 chemical substances known as alkaloids. In 1805, the alkaloid present in the largest amount (10-15 percent) was found to be a bitter-tasting powder that could serve as a powerful sedative and pain reliever; it was named morphine
what can be done to help make therapy more helpful for ppl with personality disorders
modify the therapies to suite the personalities
CBT and AUD
more often used in young people at risk in general only shows modest effects
how does meth operate
ncreasing the level of dopamine in the brain, but it is metabolized more slowly than other drugs, such as cocaine, and produces a high for a longer period of time. Prolonged use of methamphetamine causes structural changes in the brain (Chang, Alicata, et al., 2007), and the severity of psychiatric symptoms associated with the drug is related to the duration of use
psychosis and BPD
n addition to having affective and impulsive behavioral symptoms, as many as 75 percent of people with BPD have cognitive symptoms. These include relatively short or transient episodes in which they appear to be out of contact with reality and experience psychotic-like symptoms such as hallucinations, paranoid ideas, or severe dissociative symptoms (Lieb et al., 2004; Skodol, Gunderson, et al., 2002). These brief psychotic episodes are most likely to occur during times of stress, although they are present at other times as well (Stiglmayr et al., 2008). Given the many and varied symptoms of BPD, it is not surprising that this personality disorder produces significant impairment in social, academic, and occupational functioning (Bagge et al., 2004; Grant et al., 2008).
behavioral therapy and AUD
n interesting and often effective form of treatment for alcohol-related disorders is behavioral therapy, of which several types exist. One is aversive conditioning therapy, which involves the presentation of a wide range of noxious stimuli with alcohol consumption in order to suppress drinking behavior. For example, the ingestion of alcohol might be paired with an electric shock or a drug that produces nausea. A variety of pharmacological and other deterrent measures can be used in behavioral therapy after detoxification. One approach involves an intramuscular injection of emetine hydrochloride, an emetic. Before experiencing the nausea that results from the injection, a patient is given alcohol, so that the sight, smell, and taste of the beverage become associated with severe retching and vomiting. That is, a conditioned aversion to the taste and smell of alcohol develops. With repetition, this classical conditioning procedure acts as a strong deterrent to further drinking—probably in part because it adds an immediate and unpleasant physiological consequence to the more general socially aversive consequences of excessive drinking.
Serotonin: general function and general ED role
neurotransmitter that has been implicated in obsessionality, mood disorders, and impulsivity. It also modulates appetite and feeding behavior. Because many patients with eating disorders respond well to treatment with antidepressants (which target serotonin), some researchers have concluded that eating disorders involve a disruption in the serotonergic system
is purging effective
no
is punishment effective for psychopathy
no; can actually make worse
is the dopamine theory of addiction the currently held view
no; too simple 1. if substances and experiences that lead to pleasurable internal states were the whole story, then exposure to these things would explain addiction. 2. researchers have come to understand that there is not a simple, single "pleasure pathway" in the brain
biological treatments of psychopathy
none studied and they wouldn't take anyway
laxative abuse
occurs in 10 to 60 percent of patients with eating disorders (Roerrig et al., 2010) makes all of these problems much worse. Laxatives are used to induce diarrhea so that the person feels thinner or to remove unwanted calories from the body. Laxative abuse can lead to dehydration, electrolyte imbalances, and kidney disease as well as damage to the bowels and gastrointestinal tract.
BPD and comorbitiy
of those diagnosed with BPD, 85 percent also met criteria for a current or past anxiety disorder, 83 percent had had a lifetime mood disorder or episode of depression, and 78 percent met criteria for a current or past substance abuse disorder. Although it was once suggested that BPD be regarded as a variant of mood disorder because of the high comorbidity between BPD and depression, the broad scope of other disorders that are comorbid with BPD suggests otherwise. There is also substantial co-occurrence of BPD and other personality disorders. BPD can be comorbid with the full range of other personality disorders, although comorbidity with schizotypal, narcissistic, and dependent disorder is particularly high
valium and alcohol
overcome motor excitement, nausea, and vomiting; prevent withdrawal delirium and convulsions; and help alleviate the tension and anxiety associated with withdrawal. Pharmacological treatments with long-lasting benzodiazepines, such as diazepam, which reduce the severity of withdrawal symptoms, have been shown to be effective
Cluster A personality disorders
paranoid, schizoid, schizotypal People with these disorders often seem odd or eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment.
One of the reasons it is difficult to know if a disruption in the serotonin system causes eating disorders is ________
people with eating disorders often have depression as well.
what is the function of brain areas that heroin binds to
pleasure, pain, breathing
Alcohol amnestic disorder (Korsakoff's syndrome)
primary symptom is a memory defect (particularly with regard to recent events), which is sometimes accompanied by falsification of events (confabulation). People with this disorder may not recognize pictures, faces, rooms, and other objects that they have just seen, although they may feel that these people or objects are familiar. Such people increasingly tend to fill in their memory gaps with confabulations that lead to unconnected and distorted associations. These individuals may appear to be delirious, delusional, and disoriented for time and place, but ordinarily their confusion and disordered actions are closely related to their attempts to fill in memory gaps. The memory disturbance itself seems related to an inability to form new associations in a manner that renders them readily retrievable. Such a reaction usually occurs in long-time alcohol abusers after many years of excessive drinking. These patients have also been observed to show other cognitive impairments such as planning deficits (Brokate et al., 2003), intellectual decline, emotional deficits (Snitz et al., 2002), judgment deficits (Brand et al., 2003), and cortical lesions
controlled drinking
problem drinkers need not give up drinking altogether but can learn "controlled drinking," which refers to the use of techniques to drink moderately (Miller, Walters, & Bennett, 2001; Sobell & Sobell, 1995), as previously mentioned. Several approaches to learning controlled drinking have been attempted, and research has suggested that some people with alcohol use disorder can indeed learn to control their alcohol intake
which is better at predicting future aspects of criminal behavior: psychopathy or ASPD
psychopathy
Types of Anorexia Nervosa
restricting type and binge-eating/purging type
most prevalent and stable features of OCDP
rigidity, stubbornness, and perfectionism, as well as reluctance to delegate
genetics and ED
runs in families; not specific to a certain ED BN families also have alcohol and drug problems AN families also have OCD recently published data from the most powerful genome-wide association study of anorexia nervosa ever conducted (Duncan et al., 2017). This study identified a locus (a specific position or location of a gene) for anorexia nervosa on chromosome 12, in a region that has previously shown associations with Type 1 diabetes and autoimmune disorders
Thought and speech oddities comparable to those seen in schizophrenia have been documented in ________ personality disorder.
schizotypal
Synthetic cathinones
substances that mimic the effects of amphetamines and cocaine by activating the body's monoamine system like bath salts
paranoid personality disorder and schizophrenia
t is important to keep in mind that people with paranoid personalities are not usually psychotic. Most of the time they are in clear contact with reality. During periods of high stress, however, they may experience transient psychotic symptoms that last from a few minutes to a few hours (APA, 2013). People with schizophrenia share some symptoms found in paranoid personality, but they have many additional problems including more persistent loss of contact with reality, delusions, and hallucinations. Nevertheless, individuals with paranoid personality disorder do appear to be at elevated liability for schizophrenia (Lenzenweger, 2009).
history ED
take off after 50s/60s
One problem with simple examinations of personality disorders in patients with eating disorders and rebuttle
that some of the disturbances found in these patients could reflect the consequences of malnourishment. Starvation is known to increase both irritability and obsessionality (Keys et al., 1950). We must therefore be cautious in our conclusions. Even though the physiological consequences of eating disorders may exacerbate personality disturbances, they may only be enhancing traits that were present prior to the development of the illness.
One criticism of the DSM-5 is that the features of antisocial personality disorder do not fully map onto the construct of psychopathy. Some researchers are concerned that ________
the ASPD diagnosis was made reliable at the expense of the validity of the psychopathy diagnosis.
cause and importance of dx of alcohol amnestic disorder
the lack of vitamin B (thiamine). If symptoms are correctly diagnosed within the first 48 to 72 hours, treatment with thiamine leads to a reversal of this condition and memory functioning appears to be restored with prolonged abstinence. However, if undiagnosed and with disease progression beyond several days, the brain damage causing this condition becomes irreversible
For a person to be diagnosed with a paraphilic disorder, ________
the paraphilia must cause harm.
other's perspective and narcissism
they cannot do it
The most common theory about voyeurs is ________
they have difficulty relating to women and find peeping satisfies needs in a way that feels safe and powerful.
do hallucinogens induce hallucinations
usually do not in fact "create" sensory images but distort them so that an individual sees or hears things in different and unusual way
incest is an accepted practice in many cultures was once used to protect the royal blood in Egypt. has only occurred among first cousins. commonly occurs in most animal species
was once used to protect the royal blood in Egypt.
externalizing spectrum
way of looking at antisocial/psychopathy
most immediate concern with AN
weight
when are treatment outcomes better in ED
when caught earlier
when is controlled drinking more helpful
when less severe AUD
attention in psychopaths
when they are engaged in goal-directed behavior, there is an attention bottleneck and multiple channels of information (including affective information such as fear, or other cues that might be relevant) are not processed. All that matters is the single-minded pursuit of the goal
physical complications of AN
yellow skin cold blue hands/feet low BP weak increased risk for osteoporosis arrhythmias kidney damage