Psychology 509

Disruptive Mood Dysregulation vs Bipolar Disorder

(age, base rates, predominance of mood symptoms) -manic episodes are quite different -bipolar is episodic where mood dysregulation is persistent

Disruptive Mood Dysregulation vs Intermittent Explosive Disorder

(mood disruption, duration) -Dysregulation is more severe and lasts longer

Disruptive Mood Dysregulation vs Oppositional Defiant Disorder

(severity of the impairment in more than one setting, mood disruption) -Comorbidity? 15% in children, if meets criteria for both give mood dysregulation disorder diagnosis

Prognosis of Bulimia

- 75% recover - 10-20@ remain fully symptomatic - Early intervention linked with improved outcomes - Poorer prognosis when depression and substance abuse are comorbid or more sever symptomatology

Binge Eating vs Bulimia

- Absence of compensatory behaviors in Binge Eating (both share perfectionism) - Greater compulsivity anorexia, and over-control, how many calories can I survive on - Bulimia-have trouble maintain control, compulsive, only eat one and then cant maintain, undercontrol

Bipolar I

- At least one episode or mania

Bipolar II

- At least one major depressive episode with at least one episode of hypomania (Elated feeling)

Etiology of Mood Disorders: Neurobiological Factors

- Heritability estimates • 37% MDD (Sullivan et al., 2000) • 93% Bipolar Disorder (Kieseppa et al., 2004) - Much research in progress to identify specific genes involved but the results of most studies have not been replicated (Kato, 2007) • DRD4.2 gene, which influences dopamine function, appears to be related to MDD (Lopez Leon et al., 2005). • Neurotransmitters (NTs): norepinephrine, dopamine, and serotonin - Original models focused on absolute levels of NTs - MDD • Low levels of norepinephrine, dopamine, and serotonin • Mania • High levels of norepinephrine and dopamine, low levels of serotonin - However, medication alters levels immediately, yet relief takes 2-3 weeks • New models focus on sensitivity of postsynaptic receptors - Dopamine receptors may be overly sensitive in BD but lack sensitivity in MDD - Depleting tryptophan, a precursor of serotonin, causes depressive symptoms in individuals with personal or family history of depression • Individuals who are vulnerable to depression may have less sensitive serotonin receptors (Sobczak et al., 2002)

Physical Changes in Bulimia

- Menstrual irregularities - Potassium depletion from purging - Laxative use depletes electrolytes, which can cause cardiac irregularities - Loss of dental enamel from stomach acid in vomit - Mortality rate of 4% - Health complications: Unstable weight, electrolyte imbalance, dental problems, cardiac problems, hospitalization is only necessary if needs medical stabilization

Cyclothymic Disorder

- Milder, chronic form of bipolar disorder • Lasts at least 2 years in adults, 1 year in children/adolescents - Numerous periods with hypomanic and depressive symptoms • Does not meet criteria for mania or major depressive episode • Symptoms do not clear for more than 2 months at a time

Changes for DSM-IV

- Minimum frequency of binging/purging changed to once a week instead of twice a week for at least 3 months - Non-purging subtype removed

Changes from DSM-IV for Binge-Eating Disorder

- New category - This was in the Appendix in DSM-IV as a category in need of further study; additional research supports its addition to the DSM-5

Bulimia Nervosa

- Onset late adolescence or early adulthood - 90% of cases are women - 1-2% prevalence rate among women - Typically overweight people that started dieting - Normal weight range (may fluctuate)- normal BMI - Most know that they have an eating disorder - Suicide attempts and completions higher than in general population but much lower than those in anorexia nervosa - Comorbid with depression, PD's, anxiety, substance abuse, conduct disorder

Binge-Eating Disorder DSM-5 Criteria

- Recurrent episodes of binge eating; on average, at least once a week for three months - Binge eating episodes include at least three of the following (eating more rapidly than normal, uncomfortably full, large amounts when not hungry, eating alone due to embarrassment about food quantity, feeling disgusted, guilty, or depressed after the binge) - No compensatory behavior is present - 2/3 become overweight

DSM-5 Criteria for Bulimia Nervosa

- Recurrent episodes of binge-eating ( excessive amount of food consumed in under 2 hours; feeling of loss of control over eating; eats until uncomfortable) - Recurrent compensatory behaviors to prevent weight gain: Purging (vomiting), fasting, excessive exercise, use of laxatives/diuretics) - Body shape and weight are extremely important for self-evaluation - Binge eating and compensatory behaviors occur, on average at least once a week for 3 months (More common than Anorexia Nervosa)

Etiology of Eating Disorders: Cognitive Behavioral View for Bulimia

- Self-worth strongly influenced by weight • Low self-esteem - Rigid restrictive eating triggers lapses, which can become binges • Many "off-limit" foods - After binging, disgust with oneself and fear of gaining weight lead to compensatory behavior • e.g., vomiting, laxative use - Purging temporarily reduces anxiety about weight gain • Negative feelings about purging lead to lowered self-esteem, which triggers further bingeing - Stress, negative affect trigger binges - Restrained eating plays central role in bulimia • Restraint Scale measures dieting and overeating

Binge (Overeating)

- Triggered by stress or negative emotions or negative social interactions - Typical food choices: cakes, cookies, ice cream, other easily consumed high-calorie foods - Avoiding a craved food can later increase likelihood of binge - Typically occurs in secret - Reports of losing awareness or dissociation - Shame and remorse often follow

Symptoms of Manic Episode: Physiological

--decreased need for sleep (days without sleeping) + high levels of arousal --extraordinary increase in activity level hypomanic- can sleep for 2 hours and can still function -think the disorder can get worse over time when stop taking meds, sometimes worse, sometimes stead

Symptoms of Manic Episode: Cognitive

--distractibility, impulsivity --flight of ideas (racing thoughts) --feeling extremely powerful, special, or gifted (may be delusional) --inflated self-esteem; grandiosity

Symptoms of Manic Episode: Behavioral

--hyperactivity --excessive engagement in pleasurable activities (this is what gets people in trouble) More flirty/ more social, drive faster amp up high feelings, not thinking about what is going to happen in the long run, thinking "here, now, this is fun!" , wild shopping sprees, embark on risky business activities, sexual behavior --increased level of social participation (more talkative than normal, and are more distracted by unimportant things or thoughts, report thoughts are racing and "flight of ideas", in more severe forms thought disorder) -don't tolerate criticism -decreased need for sleep -high levels of arousal -in most severe form-wildy excited, sometimes only thing to do is hospitalize them (manic episode, not hypomania)

Symptoms of Manic Episode: Affective

--persistent periods of feeling great, better than usual (everything is great, feeling like you are high, but not high) Professor Gooding's professor: freaked out on her in a manic state- get very mad and said that she was wrong, and said "I could almost slap you" and started shaking and sweating- manic attack --euphoria or abnormally irritable --increased irritability, anxiety, or loss of temper

Manic Episode DSM-5 criteria

-1 week or more, person displays a continually abnormal, inflated, unrestricted mood as well as continually heightened energy or activity for most of day -Experiences 3+ of these symptoms: Grandiosity; Reduced sleep need; Increased talkativeness; Rapdily shifting ideas; Attention pulled in many directions; heightened activity; excessive pursuit of risky and problematic activities -significant distress or impairment

Major Depressive Episode DSM-5 Criteria

-2+ week period, increase in depressed mood for majority of each day and decrease in interest/enjoyment across most activities -3 or 4 of symptoms: considerable weight change/appetite; insomnia or hypersomnia; Daily agitation or decrease in motor activity; fatigue; geeligns of worthlessness; reduction in concentration; repeated focus on death/suicide -Significant distress or impairment

Prognosis of Anorexia

-50-70% eventually recover -May often take 6-7 years -relapse is common -Difficult to modify distorted view of self, especially in cultures that highly value thinness -Anorexia is life threatening -Death rate is 10x higher than general population -Death rates 2x higher than other psychological disorders

Prognosis of Binge-Eating Disorder

-About 60% recover -Binge Eating Disorder is the most common and last the longest of the three Eating Disorders (lasts around 14.4 years)

Binge-Eating Disorder

-Associated wit obesity and history of dieting - BMI > 30 -Not all obese people meet criteria for binge eating disorder Most overweight people don't binge: frequent overating/ biological, psychological, and sociocultural factors (some meds cause extreme weight gain) - Must report binge eating episodes and a feeling of loss of control over eating to qualify - Approximately 2-25% obese may qualify - Risk factors: Childhood obesity, early childhood weight loss attempts, having been taunted about their weight, low self-concept, depression and childhood physical or sexual abuse - Equally prevalent among Euro, African, Asian, and Hispanic Americans - Not large gender differences

Symptoms that occur in Both Anorexia and Bulimia

-Begin after period of dieting and fear obesity -preoccupied with food -struggled with depression, anxiety, obsessions, perfectionism -increased risk of suicide -substance abuse -distorted appearance and attitudes toward eating

Differences in Bulimia vs Anorexia

-Concerned with pleasing others and having intimate relationships -more sexually active -long histories of mood swings -trouble coping effectively/ controlling impulses and emotions -1/3 display personality disorder, borderline personality disorder -1/2 have amenorrhea (almost present in all anorexia) -serious dental problems -K deficiencies weakend body, intestinal damage, kidney disease, heart disease

Etiology Causes for Eating Disorders: Genetics

-Family and twin studies support genetic link -First-degree relatives of individuals with both disorders more likely to have the disorder -Higher MZ concordance rates for both anorexia and bulimia -Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable -Environmental factors (e.g. family interactions) play an even greater role in etiology -Further research on genetic/environmental interaction is needed -Genetics play much larger role in Anorexia than bulimia -Relatives are 7-20x greater chance of getting disorder

Treatment of Eating Disorders: Anorexia

-Help people regain lost weight, and recover from malnourishment -A. Hospitalization(treat the life threatening heart problem, hypotension, increase the likelihood of further... B. Try to get hospitalization down to as little as 18 days C. Can medically stabilize people who have lost excessive weight, gain weight D. Antidepressants can cause weight loss, so need to use SSRI to gain weight and do over a year process E. Long term success is changing the attitude/ beliefs of the individual that believes they must be fat. F. Have to be physically and mentally ready to change (more difficult to treat than bulimia) Medications -Serotonin-enhancing medications Psychological Treatments → Family therapy → Psychodynamic psychotherapy → Cognitive-behavioral therapy

Etiology Causes for Eating Disorders: Neurobiological Factors

-Hypothalamus not directly involved (produces hunger when activated) -Low levels of endogenous opioids -substances that reduce pain, enhance mood, and suppress appetite -Released during starvation -may reinforce restricted eating of anorexia -Excessive exercise increases opioids (runner's high) -Low levels of opioids (beta-endorphins) in bulimia promote craving -Reinforce binging (some try to do an activity to prevent cravings like shopping, getting nails done, whatever makes you happy) -Low serotonin metabolites in anorexics and bulimics -antidepressants that increase serotonin often effective in treatment of eating disorders -VMH-reduces hunger when activated -Dopamine related to feelings of pleasure and motivation -Anorexics feel more positive and rewarded when viewing pictures of underweight women

Physical Changes in Anorexia Nervosa

-Low blood pressure, heart rate decrease -Kidney and gastrointestinal problems -Loss of bone mass -Brittle nails, dry skin, hair loss -Lanugo (soft, downy body hair) -Depletion of potassium and sodium electrolytes (cardiac irregularity) -Amenorrhea: loss of menstrual cycles Health complications: irregular heartbeat, hypotension, infertility

Bipolar Disorder

-Lows of depression and highs of mania

Errors in Logic

-Magnification or minimization- overestimating the negative events or underestimating the positive events -Dichotomous or "All or nothing" thinking: Thinking in "all-or-nothing" terms. "If I can't do something perfectly, I may as well quit." -Overgeneralizing: Condemning yourself as a total person on the basis of a single event. "I got a C on a psychology test- I will never be a psychologist." Selective thinking: Concentrating on your weaknesses and forgetting your strengths. "It does not matter that I am a good singer. I can't dance or act" Catastrophizing: Only paying attention to the dark side of things, overestimating the chances of disaster. "I didn't get into an Ivy League school. Ill never have a decent career." Personalizing: Taking things personally that have little or nothing to do with you. "Jenny is so quiet. She must really be angry with me." Personal Ineffectiveness: Assuming you can do nothing to change your situation. "Jack always criticizes me. I wish he would quit.

Changes from DSM-IV for Anorexia Nervosa

-Restriction of behaviors that promote healthy weight rather than "refusal to eat" -In addition to fear of weight gain, a focus on behaviors that interfere with weight gain -Loss of menstrual period no longer required for diagnosis -Subtypes specified for past three months rather than just current episode

Causal factors in MDD

-abnormalilites of hormonal -Regulatory systems In patients with depression- elevated levels of cortisol, done studies that when really stressed and have a lot of cortisol- collects near abdomen (form a belly after a lot of stress that wasn't there before)

Societal Pressure: Etiology of Eating Disorders

-cultural norms, emphasis on thinness as the ideal body shape (extreme focus on body shape and weight)-self acceptance and self-esteem -certain sports equate body size with ability to succeed -track, rowing, wrestling, gymnastics all require certain body weight (can be dangerous)

Cognitive Diathesis-Stress Model

-emphasizes the diathesis rather than focusing on the stressor -accounts for heterogeneity in depression -Need to have an attributional style which is hopeless, expect negative things to happen and then when it does you are convinced its because of your thoughts, its hopeless, you're depressed

Interpersonal Psychotherapy

-focus on current relationships -rebuild some relationship that were burning bridges

Behavioral Activation Therapy (BA)

-increase participation in positively reinforcing activities to disrupt the spiral of depression, withdrawal, and avoidance

Cognitive therapy

-monitor and identify automatic thoughts, replace negative thoughts with positive

Psychological Factors in Etiology of Eating Disorders

-negative self-evaluations, low self-esteem -rigid cognitive style, all or nothing thinking (dangerous, and when you think you blew it, no going back)

Unipolar Depression

-no mania symptoms, return to normal when depression lifts -bring long lasting psychological pain that may intensify with time

Course of Major Depressive Episode Improvement

-person's symptoms impoved: period of remission/recovery -lower depressed mood People can feel depression coming on -when feel mood slipping, may need to have a higher dosage of meds if going through hard time and get up back to remission

Major Depressive Disorder DSM-5

-severe patterns of depression that is disabling/not caused by drugs/a general medical condition -different categories -Presence of major depressive episodes -No pattern of mania/hypomania

Hypomania

-when your mood reverses- and switches to depression and just stop what you were just doing and don't finish your initial plan

Psychological Treatments of Major Depression

1. Cognitive Therapy (convince depressed clients mood can be brought under control and manipulate variables to improve mood and prevent further depression) 2. Behavioral Therapy 3. Psychodynamic Therapy If have 3+ episodes, going to keep having them so psychologist needs to help you control the episodes that are going to keep happening -Most rely on cognitive-behaviroal therapy

What is more common Bipolar I or Bipolar II?

Bipolar I is more common than Bipolar Equally common in men and women (women have more depressive episodes and rapid cycling)

Biological Theories of Depression

Causes of unipolar depression -Brain anatomy and brain circuits --determined that emotional reactions of various kinds are tied to brain circuits --these are networks of brain structures that work together, triggering, each other into action and producing a particular kind of emotional reaction --It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD -Although research is far from complete a circuit responsible for unipolar depression has begun to emerge --Likely brain areas in the circuit include the prefrontal cortex (lower blood flow), hippocampus (can produce new neurons during depression and appears smaller), amygdala (neg. thoughts/emotions; 50% more active with more Blood Flow), and Brodmann Area 25 (smaller in depressed/more active "depression switch") -Hypersomnia- sleep like all the time, have psychomotor retardation

In order of increasing severity for bipolar disorders

Cyclothymia -> Bipolar II -> Bipolar I

Seligman's Learned Helplessness Model:

Depression results from being in aversive situations in which one has no control over the outcome. Seligman, Abramson et al. focused on three attributional dimensions: • internal/external • global/specific • stable/unstable The internal, global, and stable attributions are most likely to lead to depression. Example: physics- take an exam and turns out harder than thought, and only got 10/50, and really worked hard and think not cut out for this, and think not very good of these pre-med courses (magnified) and it wont get better, always going to be this way, no matter what you do you blow everything and just study physics and it doesn't change (depressing)

Premenstrual Dysphoric Disorder

Diagnosis given to women who repeatedly have depressive symptoms the week before her period

DSM-5 Criteria of Anorexia Nervosa

Doesn't eat enough food to hold a healthy weight and result is significant weight loss 1) Individual purposely takes in too little nourishment, resulting in body weight that is very low and below that of other people of similar age and gender (BMI <18.5) 2) Fear of gaining weight; seeks to prevent weight gain (cant be too thin) 3) Distorted body image, inappropriate emphasis on weight or shape in judgments of themselves, fails to appreciate the serious implications of low body weight

How do Dysthymia and Cyclothymia relate?

Dysthymia is to unipolar disorder as Cyclothymia is to bipolar

Unipolar Depression Symptoms (Emotional, Motivational, Behavioral, Cognitive, Physical)

Emotional Symptoms • Feeling miserable, empty, and humiliated • Experiencing little pleasure Motivational Symptoms • Lacking drive, initiative, spontanaeity • Between 6% and 15% of those with severe depression die by suicide o Most dangerous when they are starting to feel better- active and depressed Behavioral Symptoms • Less active, less productive Cognitive Symptoms • Hold negative views of themselves • Blame themselves for unfortunate events • Pessimistic Physical Symptoms • Headaches, dizzy spells, general pain

BIPOLAR I

Full manic and major depressive episodes -alteration of episodes weeks of mania followed by wellness, followed by depression -mixed features- display both mania/depression within same episode (racing thoughts amidst extreme sadness) -Episode: 5-8 days in length

Cognitive Therapy for Depression

Goal: To challenge and change the maladaptive automatic thoughts that contribute to depression -no more than 20 sessions -learn to challenge thoughts, changing explanatory style and change them

Behavior Therapy for Depression

Goal: To encourage clients to avoid social isolation and restriction of activities that may be contributing to their depression. -don't contribute activities that promote their depression

Psychodynamic Therapy for Depression

Goal: To encourage clients to strengthen social relationships that provide personal satisfaction.

Diathesis Graph of Depression: Long/long, short/short/ vs long/short alleles

Life Event interact with serotonin Transporter gene to predict symptoms of Depression -Polymorphism or variation (2 long alleles, 2 short alleles, or one short one long) -gene environment interaction (so vulnerable to the stressors around you) -need gene plus envionrment interation -assoicated with greater likelihood of developing depression (ages 21-26) -number of stressful life events vs self-reported depression symptoms at age 26 long, long allele: didn't matter-kind of okay (need 9 or above stressors to be diagnosed) -short/long- intermediate reactions don't want a short alle for serotonin transporter gene

Cyclothymia

Low grade depression & hypomania -not hospitalized -symptoms of hypomania, but symptoms didn't meet full criteria for a major depressive disorder -Milder, chronic, form of bipolar disorder, 2 years (adults) 1 year (children), symptoms do not clear for more than 2+ months at a time

BIPOLAR II

Major depression & hypomania -needs to take Prozac plus mood stabilizer -Diagnosed first with depressive episode then have a manic episode and then may have a different response to typical treatments

HORMONES and MOOD DISORDERS HPA: Hypothalamic Pituitary Adrenal Axis Etiology of Mood Disorders Neuroendocrine System

Overactivity of HPA axis - Triggers release of cortisol, stress hormone • Amygdala overreactive Findings that link depression to high cortisol levels - Cushing's syndrome • Causes oversecretion of cortisol • Symptoms include those of depression - Injecting cortisol in animals produces depressive symptoms - Dexamethasone suppression test • Lack of cortisol suppression in people with history of depression

Anorexia vs Bulimia

Prevalence Gender Ratio: Anorexia (0.5-2% 10 to 20: 1 females:males); Bulimia (1-3% 10:1 females: males) Personality traits: (Anorexia: Greater harm avoidance, Persistence, Conscientiousness, Perfectionism) (Bulimia: Greater novelty seeking, negative emotionality, social insecurity, feelings of ineffectiveness, stress reactivity, perfectionism) Associated clinical features: (Anorexia: Compulsivity, Overcontrol) (Bulimia: Affective Dysregulation, Impulsivity, undercontrol)

Manualized Cognitive Therapy for Depression

Provide rational for the therapy Train the client in self monitoring their mood-mood chart Behavioral activation strategy- therapist has client engage in a new activity: fun -line dancing, something inexpensive and do it with other people Train clinet to identifiy automatic thoughts Teach client to value automatic thoughts and show them Help Explore, assumption that holds together some of these thoughts Relapse prevention (make thoughts less likely to occur: VERY important)

Treatment of Eating Disorders: Bulimia

Psychological Treatments → Cognitive-behavioral therapy (education, behavior change, modification of thoughts, eat more frequently- just small portions, encourage clients to avoid being alone, structure lives to be around others, have an eating buddy and get support that you need)-no forbidden food-(gains maintained) → Interpersonal therapy (IPT)- have emotional problems, or interpersonal-psychodynamic including behavioral elements (proven to work)-improvement continued after posstreatment 6+ years) → Dialectical behavior therapy (DBT)-newer approach- treat compulsive behavior, binges cause person to feel regrets, people who receive this are significantly less likely to binge or purge, don't know how it compares to other therapies → Relapse is common (need someone to help the person develop critical coping skills → People binge when have low moods, depression, sadness, a response to adverse emotional state (coping mechanism)- feel numb, alleviate stress, usually occur when alone → Combine meds and behavioral modification Medications + Inpatient Treatment Program -SSRIs Medications + Self Help Manual -SSRIs

Schematic of cognitive behavioral theory of bulimia

Pursuit of Thinness--> Restrictive Dieting--> Deprivation & Hunger--> Binge --> Purging --> Guilt/Shame -->

What are two types of Anorexia Nervosa?

Restricting: -restrict their food intake by at first cutting out sweets/fattening snacks, then increasingly eliminate other foods -weight loss is achieved with no binge-eating/purging during last three months Binge-eating/ Purging - The person has also regularly engaged in bine-eating and purging during the last three months - lose weight by forcing themselves to vomit after meals/ abuse laxatives and diuretics

Depression symptoms around the world: Similarities, Differences between non-western countries and western countries

Similar: sadness, joylessness, anxiety, tension, lack of energy, loss of interest, loss of ability to concentrate, thoughts of suicide Differences: -Non-Western Countries: physical symptoms, less marked by cognitive symptoms like self-blame and guilt -Minorities- might have depression because many have a more limited treatment options

Lewinsohn's Behavioral Model

Stressful life events → reduction in reinforcers → person withdraws → further reduction in reinforcers → more withdrawal & depression • Depression results from changes in rewards and punishments people receive in their lives • Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors and they spiral toward depression • Research supports the relationship between the number of rewards received

Mania

The opposite of depression, is a state of breathless euphoria (frenzied energy) in which people may have an exaggerated belief that the world is their for the taking.

When/ Who does Anorexia Affect a person

Triggered by dieting and stress of traumatic event (could begin with slightly overweight person) -Women 10x as likely to develop disorder than men -95% of anorexia nervosa occurs in females -Suicide rates are high: 5% completing; 20% attempting -Often comorbid with: depression, OCD, phobias, panic, alcoholism, personality disorders (for women) -for men often with: substance dependence, mood disorders, or schizophrenia -Fear provides motivation -preoccupied with food (lots of time thinking/planning/reading about food) -consider themselves to be unattractive

Mania

dramatic and inappropriate rises in mood, affects same areas as depression but in opposite ways -Active, powerful emotions, no restriction -some aren't happy but instead very irritable and angry -people less likely to take meds when experiencing mania -5-8 days (more severe)

Family-focused Therapy

educate family and enhance family communication

Behavioral Couples Therapy

enhance communication and satisfaction

IPT for Depression

how interactions are preventing them from having satisfying social relationships -How to solve interpersonal disrupts -how to develop new relationships Strenghten social relationships and strengthen bonds that prevent satisfaction

Depression

low, sad state in which life seems dark and its challenges overwhelming

Psychoeducational Approaches

provides information about symptoms, course, triggers, and treatments

Hypomania

still problematic, but don't end up in as much trouble, still poor judgement -4 days

Mindfulness-Based Cognitive Therapy

strategies to avoid/prevent lapse

Cognitive Theory for MDD: Rumination Theory

• A specific way of thinking: tendency to repetitively dwell on sad thoughts (Nolen-Hoeksema, 1991) • Women usually dwell on sad thoughts and talk them over • Men usually distract from the sad thoughts by being productive • Most detrimental is to brood over causes of events

Etiology of Eating Disorders: Cross-Cultural Factors

• Anorexia found in many cultures - Even those not under Western influence - May not include fears of getting fat • In some cultures, higher weight is a sign of fertility and healthiness • As countries become more like Western cultures, eating disorders increase • Bulimia more common in industrialized societies than non-industrialized ones More common in industrialized areas, seen in less places were food is scare

Treatment of Eating Disorders: Binge-Eating Disorder

• CBT shown to be effective treatment modality • ---teaches restrained eating through self-monitoring, self-control, and problem solving skills (more effective than medication) • CBT more effective than medication • Interpersonal Therapy (IPT) equally as effective as CBT • Behavioral weight-loss programs may promote weight loss, but do not curb binge eating

Etiology of Eating Disorders: Sociocultural Factors

• Dieting, especially among women, has become more prevalent - Often precedes onset • Body dissatisfaction and preoccupation with thinness also predict eating disorders • Societal objectification of women - Women viewed as sexual objects • Unrealistic media portrayals - Women may feel shame when they don't match the ideal • Overweight individuals are viewed with disdain, creating more pressure to be thin

Dysthymia DSM-5 Criteria

• Less severe depression, chronic in nature. • Depressed mood for most of the day, for more days than not for at least 2 years in adults and 1 year in children • Poor appetite and overeating • Insomnia or hypersomnia • Low energy or fatigue • Low self esteem • Poor concentration or difficulty making decisions • Feelings of hopelessness • Can't be symptom free for more than 2 months at a time

Psychodynamic Model for MDD

• Loss of a loved one regress to oral stage and experience introjection - projecting feelings for loved one onto self • If this doesn't pass, grief worsens • Instead of actual loss, some experience "symbolic" loss • Newer psychoanalysis propose depression results when peoples relationships leave them feeling unsafe and insecure

Hopelessness Theory

• Most important trigger of depression is hopelessness • Desirable outcomes will not occur • Person has no ability to change situation

Cognitive Theory for MDD: Beck's Theory

• Negative triad: negative view of self, world, future o Distortion of ones experiences, oneself, and one's future in ways that increase the likelihood of feeling depressed • Negative schema: underlying tendency to see the world negatively • Cognitive structures or attitudes that form in childhood and thereafter to organize the individuals world o • Negative schema cause cognitive biases: tendency to process information in negative ways • Maladaptive attitudes o Self defeating attitudes are developed during childhood o Upsetting situations later in life

Etiology of Eating Disorders: Gender Factors

• Objectification of women's bodies - Women defined by their bodies; men defined by their accomplishments - Societal objectification of women leads to "self-objectification" • Women see their own bodies through the eyes of others • Leads to more shame when fall short of cultural ideals

Epidemiology and Consequences for Bipolar Disorders

• Prevalence rates lower than MDD - 1% in U. S.; 0.6% worldwide for Bipolar I - 0.4% - 2% for Bipolar II - 4% for Cyclothymia • Average age of onset in 20s • No gender differences in Bipolar I Disorder - Women experience more depressive episodes • Severe mental illness - A third unemployed a year after hospitalization (Harrow et al., 1990) - Suicide rates high (Angst et al., 2002)

Prevention of Eating Disorders

• Psychoeducational approaches - Educate early about the dangers of eating disorders • De-emphasize sociocultural influences - Dissonance reduction intervention to deemphasize sociocultural influences • Risk-Factor Approach - Healthy weight intervention to develop healthy weight and exercise programs

DSM-5 Criteria for Disruptive Mood Dysregulation Disorder

• Severe recurrent temper outbursts in response to common stressors, including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation • Temper outbursts are inconsistent with developmental level • The temper outbursts tend to occur at least three times per week Persistent negative mood between temper outbursts most days, and the negative mood is observable to others • These symptoms have been present for at least 12 months and do not clear for more than 3 months at a time • Temper outbursts or negative mood are present in at least two settings (at home, at school, or with peers) and are severe in at least in one setting • Age 6 or higher (or equivalent developmental level) • Onset before age 10 • What do they look like after age 18? - no bipolar disorder- either unipolar depressive disorder or anxiety disorder

Cognitive Theory for MDD: Attributional Style

• Stable and Global attributions can cause hopelessness

Brain Imaging Research Structural studies vs. Functional imaging studies

• Structural studies: o Focus on number of or connections among cells • Functional activation studies o Focus on activity levels

Epidemiology and Consequences of Major Depressive Disorder

• Symptom variation across cultures - Latino cultures • Complaints of nerves and headaches - Asian cultures • Complaints of weakness, fatigue, and poor concentration - Smaller distance from equator (longer day length) and higher fish consumption associated with lower rates of MDD • Symptom variation across life span - Children • Stomach and headaches - Older adults • Distractibility and forgetfulness • Co-morbidity - 2/3 of those with MDD will also meet criteria for anxiety disorder at some point

Social and Psychological Factors in Bipolar Disorder

• Triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes - Negative life events, neuroticism, negative cognitions, expressed emotion, and lack of social support • Predictors of Mania - Reward sensitivity (very sensitive activation system; something good happens and you are psyched, got an A on a test- if have bipolar so excited cant sleep/eat, think straight, just buzzing and today A tomorrow conquer the world, I can cure cancer, fly) - Sleep disruption

Symptoms of Depression: Cognitive

• changes in concentration, decision making • thinking negatively about oneself &one's future • feeling guilty or remorseful, self-denigration (may be delusional) • recurrent thoughts of death or suicide

Symptoms of Depression: Physiological

• changes in weight (10% of body weight) • changes in appetite (too little or too much)(foods don't taste good anymore) • changes in sleep habits (sleeping too much or too little, awakening earlier than usual and having trouble getting back to sleep in early morning hours)

Symptoms of Depression: Affective

• persistent periods of feeling down, depressed, or sad • tearfulness or crying • increased irritability, anxiety, or loss of temper • reduced interest in things which used to be enjoyable

Symptoms of Depression: Behavioral

• psychomotor retardation or psychomotor agitation (move slowly) • functioning less effectively than usual at work or school • reduced level of social participation • lack of energy, feeling unmotivated