PSYC 2300, Exam 2

biofeedback training,

a therapist teaches you to voluntarily control a physiological function, such as heart rate or blood pressure. During training, you would receive second-by-second information (feedback) regarding a specific physiological activity. If you were trying to lower blood pressure, for example, you would receive feedback on your blood pressure, presented visually on a screen or via auditory signals. After repeated training sessions, you would be able to maintain your blood pressure in the desired range.

Conversion Disorder

(Functional Neurological Symptom Disorder) § Complaints of altered motor or sensory function § Clinical findings provide evidence of incompatibility between the symptoms and supposed condition § Symptom groups: motor deficits, sensory deficits, and seizures/convulsions Glov e A ne st hes ia. A pe rson with co nve rsion dis ord er mig ht desc ribe nu mb ness in the en tire ha nd or w rist, as sh own h ere . H oweve r, the n erv es t hat tr ans mit pai n si gnals d o not st op at the w rist— they continue up the arm. Numbness that stops at the wrist is not anatomically possible.

Mixed features

(i.e., three or more symptoms of hypomania/mania or depression occurring during an episode from the opposite pole) are common with both bipolar I and bipolar II (Judd et al., 2012). Mixed features is important to note because when hypomanic/manic symptoms occur with depressive symptoms, the risk of impulsive behaviors such as suicidal actions or substance abuse increases; those who have this pattern often require more intensive treatment

hypothalamic-pituitary-adrenal (HPA) axis

(the system involved in stress and trauma reactions) then releases hormones, including epinephrine and cortisol. These hormones prepare the body for "fight or flight" by raising blood pressure, blood sugar levels, and heart rate; the body is thus prepared to react to the potentially dangerous situation (Stahl & Wise, 2008). Cortisol also helps the body return to normal (i.e., restore homeostasis) after the stressor is removed.

PTSD Just Don't Think About It

- Worst thing -Traumatized people try to cope by ignoring the upsetting thoughts, it seems sensible, but it doesn't work. -Hard to not think about something when you tell them not to -Thought suppression has a peridoxical effect

Age of Onset

-AN and BN typically beigin in late adolescence/early adulthood -hormonal changes, autonomy struggles, problems with sexuality, and reactions to normal changes in body weight and shape may all play some role • Risk declines with age

African American inherited trauma

-African American traumatic cultural history -kidnapping, from Africa, slavery, -socially sanctioned rape, Jim Crow & segregation, marginalization, and discrimination into current times (Williams, Gooden, & Davis, 2012) • Also called post-traumatic slave syndrome (Leary, 2005) • Identity, ongoing, and cumulative trauma (Kira, 2010)

Cultural Bound Syndrome?

-Beauty has become increasingly equated with thinness in our culture -eating disorders more

Classification

-Bipolar I -Bipolar II -Cyclothymia -Exclusionary criteria

Spec. ex. of Inherited Trauma

-Children and grndchildren of Holocaust survivors -biological and inherited mechanisms identified -Cultural trauma in descendants of Japanese of WWII incarceration -negative consequences for their identity of those imprisoned and their offspring -Native American Exp. -High rates of addiction, suicide, mental illness, sexual violence and etc. from historical trauma

Medical Complications

-Constipation,abnormal pain, intolerence to cold, and lethargy common -blood pressure and body temperature may fall below normal -Dermatological problems—dry or cracked skin; lanugo on face or body • Anemia, impaired kidney functioning, cardiovascular difficulties, dental erosion, bone loss • Electrolyte imbalance—disturbances in levels of potassium, sodium, calcium, etc. can lead to cardiac arrest, kidney failure • Medical problems can be serious and lead to death

PTSD: PSychotherapy (CBT) Stress Inoculation Training

-Shouldn't be used • Stress Inoculation Training • Education about trauma • Anxiety management strategies (e.g., controlled breathing, cognitive restructuring) • Collaboratively select strategies and practice implementation

Trauma can be Inherited

-Env. information registered by an ancestral generation -Environmental information registered by an ancestral generation can be passed down to descendants via two routes: social transmission and biological inheritance (Dias & Ressler, 2014) -Mice shocked and cherry blossom/ rose water. When mice reproduced when the baby mice presented smell of cherry blossom had same fear/ anxiety response and even grand children. (epigenetic)- Actual changes in DNA expressed in next generations

Medical Complications

-Excessive gag reflex from repeated vomitting -Enlargement of the salivary glands -dentist most likely to reccomend • Dental enamel erosion • Electrolyte imbalances with associated serious medical consequences • Ruptures of esophagus or stomach occasionally occur and can lead to death

Most effective are CBT with Exposure-based Treatment

-Exposure-based treatment approaches have been shown to be effective -Prolonged exposure had the most support in the research literature for the treatment of trauma • The traumatized person revisits the trauma in their imagination with a supportive counselor • The traumatized person stops avoiding

DSM-5 Overview

-Feeding and eating • Pica • Rumination Disorder • Avoidant/Restrictive Food Intake Disorder • Anorexia nervosa • Bulimia nervosa • Binge Eating Disorder • Persistent disturbance in eating behaviors that results in altered consumption/absorption of food and leads to impairments in physical health or psychosocial functioning

Shame and Secrecy in PTSD

-Feelings of helplessness lead to shame -(shame) who they are inside. -Shame leads to secrecy -Secrecy is BAD.. it prevents talking about it and talking leads to natural healing -May feel that talking about it makes them anxious -Prevents others from being supportive leading to isolation • prevents thinking about the trauma in new ways and emotional growth (processing)

Racism-Related Trauma Cumulative

-For most traumatic experiences people show signs of re-experiencing (intrusion) the events. In the case of race-based traumatic stress, encounters may be clusteres or cumulative and a last straw even may serve as a trigger for the trauma -Many minorities report their stress is not because of one event, but a series of emotional wounds and blows experienced

Stressful Life Events

-Holmes and Rahe's Social Readjustment Rating Scale (SRRS) assigned stress values to life events -Assigns stress values to life events based on the judgements of a large group of normal adults -The SRRS views stressors that produce more life change units as causing more stress -Most stressful: Death of a spouse, divorce, separation, jail, death of family member, personal injury

Developmental Factors in Bipolar Disorder

-In children, mania may be chronic (irritability and temper tantrums) -difficulty in differentiating bipolar disorder from ADHD, conduct disorder, ODD, and schizophrenia -Onset in childhood and adolescent more severe -older adult population 1% over 60 report bipolar disorder -After that age, mania and depression symptoms result likely from medical illness esp. stroke (Van Gerpen et al., 1999) -Time span betweenmania and depression factors

Bipolar Disorders

-Includes cycles of depression and mania or hypomania -MDD more common than bipolar (5:1) -Lifetime risk of bipolar 1% ¡ The lifetime risk of for bipolar I and II disorders combined is close to 4% -Gender differences not typically observed for bipolar mood disorders (Merikangas, 2007)

Male Depression

-Men 3 times more likely to be alcoholic -male relatives of female depressed patients more likely to be alcoholic -Manifestation of same underlying pathology?

Medications for PTSD

-Not generally effective. -Can reduce some symptoms. -No medicines cure it. -Psychological treatments should be first line approach

PTSD and Culture

-PTSD rates higher among African Americans -9.1% compared to 6.8% of European -Blacks of all ages are more likely to be victims - increased risk for victimization due to lower income and dangers of urban life • Most inner-city African Americans with PTSD never receive any mental health treatment (Graves et al., 2011) • The trauma of PTSD may be compounded by racism (Helms et al., 2011)

PTSD Factors Influencing Teatment Outcome

-Pretreatment variables=poorer outcomes -Trauma-related -childhood trauma, multiple traumas, personal vs. impersonal trauma, time since trauma, whether injured during trauma -Personal Characteristic -Male, gender, suicidal, living alone, comorbid GAD, anger problems -General treatment variables=poorer outcomes -low credibility of treatment, how motivated they are to get better, less completed homework

Cumulative Trauma

-Previous exposure to trauma and PTSD effects of subsequent trauma: results from the detrouit area survey of trauma -History of any previous exposure to traumatic events associated w. a greater trisk of PTSD from the index trauma -multiple previous events had a strong effect then single event - Results Consistent with sensitization hypotheses

Treatments for Depression

-Psychotherapy cognitive and behavior therapy Interpersonal therapy Psychodynamic therapies -Antidepressant medications tricyclics monoamine oxidase inhibitors selective serotonin reuptake inhibitors herbal remedies -ECT

How Racism Causes Trauma

-Racist incidents are traumatic -They may affects surviviors in ways that are analogous to the effect that rape and domestic violence have on their victims -Act as a violation of an individuals personhood The victim feels disempowered/powerless • Event is unpredictable and uncontrollable • May be challenged or ridiculed by others

Anorexia Nervosa

-Restriction of energy 9food) ntake -Fear of gaining weight or becoming fat -Distubances in perception or importance of normal body weight

Psychological Factors

-Struggle for perfection -People with anorexia are more likelt to: 1) exhibit excessive conformity 2) struggle to maintain self-control 3) take pride in their abilitty • Among bulimics • Self-esteem and much of daily routine center on weight, diet, and appearance • People with bulimia are very sensitive to others' comments about their weight or appearance -may lack introceptive awareness-recogntion of internal cues (may include emotional states) • Depressive symptoms • Low self esteem, self-confidence • Negative body image • Dietary restraint, leads to binging

Historical Perspective

-The term anorexia Nervosa was coined in 1874 -rarely referred to or studied until 1960's -Diagnoses of anorexia nervosa and bulimia nervosa first appeared in DSM-III in 1980

Bulimia Nervosa

-binge eating and feeling out of control -inappropriate compensatory behavior (purging) -at leas 1 episode per week over 3 months -undue influence of weight and body shape on self-evaluation -does not occur solely during anorexia nervosa

Adjustment Disorder

-involve clinically significant symptoms in response to stress, but the symptoms are not severe enogh to warrant classification as another mental disorder -smilar to acute stress disorders and posttraumatic disorders because stress causes all 3 conditions -can be reation to stressor of any severity not just traumatic stress.

PTSD Recovery

-most people recover on their own -Some people continue to feel traumatized log after the event -When symptoms of trauma last more than 1 month, a person may be diagnosed -When symptoms last a year then they are unlikely to get better on their own -Any major life change can be traumatizing DSM-5 any bad thing that happens has the potential of causing trauma in an individual

What causes of Bipolar Disorder?

-social factors -Psychological factors -biological factors -Heritability for bipolar is about 80%

Suicide among elderly

-suicide rates for elderly men are the highest among any age group (elderly white men). Greater emphasis on working. -Suicide likely to accompany depression -Factors for increased risk: 1. significant health issues 2. loss of independence 3.Bereavement 4. serious financial and relationship problems

Treatment of Bulimia Nervosa

1) CBT • Significantly reduces binge eating and purging (70% reduction in unwanted behaviors) • Individual or group approaches effective • Education and behavioral strategies to normalize eating patterns • Challenging dysfunctional beliefs about self, appearance, and dieting • Preparing strategies for coping with expected relapses 2) Interpersonal Psycotherapy • focuses on difficulties in close relationships, not eating • appears to have long-term benefits equal to those of cognitive behavior therapy 3) Anti-depressant medications • somewhat effective but does not supplant psychotherapy as the treatment of choice

Suicide in LGB Adolescents

1) LB Adolescent girls comit suicide and think about it 2) Non-LB Adolescent girls

Suicide in Sexual Minorities

1) Trans or gender non-conforming 2) Lesbian, gay, or bisexual 3) Overall population

PTSD Marked alterarions in arousal and reactivity

1) irritable or aggressive behavior 2) reckless or self-destructive behavior 3) hyper-vigilance 4) exaggerated startle response 5) problems with concentration 6) sleep disturbance - often turn to alcohol and drugs

What are those who are suicidal thinking?

1. Belief that things will never change and suicide is the only solution 2. Desire to escape from psychological pain and distressing thoughts 3. Triggering events including intense interpersonal conflicts and feelings of depression, hoplessness, guilt, anger, or shame 4. perceived inability to make progress toward goals or t o solve problems, related feelings of failure, wothlessness and hoplessness 5. ambivalence about suicide, there is a strong underlying desire to live 6. Suicidal intent is communicated directly or indirectly through verbal or behavioral cues

Choice of Method for SUicide

1. Firearms -more than 50% of completed suicides 2. Drug overdose -70% of suicide 3. Hanging suffocation -increased in recent years for all groups -especially 45-59 Older adolescents most frequently try hanging, jumping, and using firearms

Treating PTSD

1. establishing a trusting therapeutic rel. 2. providing education about the process of coping w/ trauma 3. strees-management training 4. encouraging the re-visiting of the trauma and 5. integrating the traumatic event into the individual's exp.

Definition of PTSD

1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) 2. recurrent distressing dreams in which the content or affect of the dream is related to the event(s) 3. dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) are recurring (may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings) 4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) 5. marked physiological reactions to reminders of the traumatic event(s)

Treatment of Anorexia Nervosa

2 goals: -weight gain, including use of inpatient settings with coercive methds if necessary (forced feeding, strict behavior therapy programs) Adress the difficulties that cause or maintan the problems -commonly through individual and family therapy • Issues addressed include autonomy and roles within the family, interoceptive awareness, distorted bodily perceptions and beliefs about weight or shape, and pursuing one's own values

DSM-5: Manic Episode

3 or more of the following symptoms -inflated self-esteem/grandiosity -decreased need for sleep -more talkative or pressure to keep talking -flight of ideas (racing thoughts) -distractibility -increase in goal-directed behaviors -activities with painful consequences

Obesity is currently defined as having a body mass index (BMI) greater than ____

30

Pictorial Representation of Suicide Prevalence

8.7 million serious thoughts of suicide 2.5 million suicide plans 1 million plans and attempted suicide .1 million no plans and attempted suicide 1.1 million attempted suicide

Persistent Depressive disorder (dysthymia)

A chronic state of depression; the symptoms are the same as those major depression, but they are less severe-goes on longer persistent, lasting two or more years and an individual is never w/o symptoms for more than two months leads to severe outcomes (social isolation, high suicide risk, and mislabeled as moody or difficult)

Malingering a craft skill or a facade?

A condition in which physical symptoms are produced intentionally to avoid military service, criminal prosecution, or work, or to obtain financial compensation or drugs

National Body Survey

A national survey found that almost half of American women have a negative body image, particularly about their waist, hips, and/or thighs.

Percentage of women reporting dissatisfaction

A national survey found that almost half of American women have a negative body image, particularly about their waist, hips, and/or thighs.

What is the most robust predictor of a suicide attempt?

A previous suicide attempt

Treating Dissociative Amnesia and Dissociative Fugue

A reasonable therapeutic approach is to treat these dissociative disorders indirectly by alleviating the depression and the stress that may underlie dissociative symptoms with antidepressants, cognitive-behavioral therapy, and stress management techniques.

What is a psychological autopsy?

A systematic review of information after a person dies to try to understand his or her behavior before death

Social Dimension

A variety of social factors appear to influence somatic symptom and related disorders. Some individuals with SSD report being rejected or abused by family members and feeling unloved

Trauma-Related Disorders in DSM-5

Acute Stress Disorder, Post-traumatic Stress Disorder (PTSD), Adjustment Disorder, Reactive Attachment Disorder, Disinhibited Social Engagement Disorder -DSM-5 Pulled out of anxiety disorder

Six Categories of Adjustment Disorders

Adjustment disorder • with depressed mood • with anxiety • with mixed anxiety and depressed mood • with disturbance of conduct • with mixed disturbance of emotions and conduct • unspecified • Occurs in response to an identifiable stressor within the last 3 months • Does not persist beyond 6 months after stressor has terminated

Features of Clinical Depression The ABC's

Affect affect: pattern of observable behaviors (facial expression, pitch of voice, body movements) Emotion: state of arousal defined by subjective states of feeling Mood: a pervasive and sustained emotional (sadness, anger disgust)response that can color perception Behavior- withdrawing from things, fatigue, difficulty sleeping, changes in appetite Cognitions (thoughts)- difficulty concentrating

MDD Major Depressive Disorder

Affects 9.9. million American adults per year Leading cause of disability in the U.S. Accounts for 10% of all disability Median age of onset is 30 yrs 30% sought professional help in last 6 months can lead to suicide

Ethnic comparisons suggest that _____ women in the U.S. have the highest levels of body satisfaction.

African American

Eating Disorders By Race & Ethnicity

African American: Anorexia Nervosa 0.14% (0.08),Bulimia Nervosa 1.90% (0.30), BED (modified) 2.36% (0.37),Any Binge Eating 5.82% (0.41), Latina/o American (NLAAS; n=1,427): Anorexia .12%, Bulimia 1.91%, BED 2.31%, any binge eating 5.8% Asian American: Anorexia .12%, Bulimia 1.42%, BED 2.67%, any binge eating 4.71% US Representative: Anorexia .9%, Bulimia 1.5%, BED 3.5%, and any binge eating 4.9%

Differences in symptom presentation

Age- younger generations have more depression and an earlier onset then other generations Cross culturally

EFFECTS OF ALCOHOL ABUSE

Alcohol poisoning • Can result in impaired breathing, coma, and death • Alcohol-use disorder • Twice as likely to develop in men • Alcoholism progresses more quickly in women • Delirium tremens • Life-threatening condition produced by alcohol withdrawal symptoms

Subtypes of Anorexia Nervosa

Although the popular view of an individual with anorexia nervosa is a person who eats very little, there are actually two subtypes of the disorder: the restricting type and the binge-eating/purging type. The restricting type involves weight loss through severe dieting or exercising. The binge-eating/purging type involves self-induced vomiting or use of laxatives or diuretics to control weight, often after binge eating. Although both groups vigorously pursue thinness, they differ in some aspects. Those with the restricting type of anorexia nervosa are more introverted and tend to deny psychological distress or feelings of hunger. Those with the binge-eating/purging type are more extroverted and impulsive; report more anxiety, depression, and guilt; often have a strong appetite; and tend to be older

Dissociative Amnesia

Amnesia vs. Dissociative Amnesia § Both deal with the inability to recall important information; however, amnesia occurs after a medical condition or event, and dissociative amnesia follows trauma § Three types of dissociative amnesia § Localized amnesia § Generalized amnesia § Selective amnesia

muscle dysmorphia

An extreme dissatisfaction with one's muscularity

Physical Complications

Anorexia nervosa is associated with serious medical complications. The mortality rate is up to 6 times higher than that of the general population due to suicide, substance abuse, and the physiological effects of starvation Self-starvation produces a variety of physical problems such as irregular heart rate and low blood pressure. In addition, starvation causes the heart to become damaged when the body is forced to use muscles as a source of energy. Other physical changes include extreme fatigue, dry skin, brittle hair, low body temperature, and kidney disease Those who purge often develop enlarged salivary glands, resulting in a "chipmunk look" to the face

Differences and similarities between anorexia nervosa and Bulimia nervosa

Anorexia: Extreme diet, below minimally normal weight, denial of anorexia "proud of diet", comforted by rigid self control, unduly influenced by body weight/shape, some cases of AN also binge and purge, prevalent among high SES, young female Bulimia Nervosa: Binge eating/compensatory behavior, normal weight, aware of problem, secretive/ashamed of bulimia, distressed by lack of control, unduly influenced by body weight/shape, many cases of BN have history of AN, prevalent among high SES, young female

Biological Treatment SSD

Antidepressant medications such as selective serotonin reuptake inhibitors

Treatment factors involved in dissociative disorders

Antidepressents cognitive-behavioral therapy -focus on your surroundings (treatment) used to work on misinterpretation of normal symptoms of fatigue, stress, or even substance abuse challenge misinterpretations by teaching to explore alternative explanations (cognitive restructuring) exposure therapy to face fears

Stress

Any challenging event that requires physiological, cognitive, or behavioral adaption -Stress was thought to contribute to psychodynamic disorders a term indicating that a disease is a product of both the psych (mind/ psyche) and body/ soma

From what assumption do suicide crisis workers operate when they are talking with someone who is considering suicide?

Anyone considering suicide is ambivalent about the act.

Physiological Symptoms in Depression

Appetite and weight changes. Sleep disturbance. Unexplained aches and pain. Aversion to sexual activity.

Definition of PTSD

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following: 1. irritable or aggressive behavior 2. reckless or self-destructive behavior 3. hypervigilance 4. exaggerated startle response 5. problems with concentration 6. sleep disturbance

Preventing Suicide

Early detection -understanding risk ad protective factors Paths to intervention -self-referrals or referrals from concerned family or friends -gatekeeper training -designated people within a system learn about risk factors and screening methods

Possible reasons for increase of suicide in children and adolescents

Bullying -victims of bullying are two to nine times more likely to consider suicide than those not subject to bullying • Copycat suicides • Media reports • Decreased use of antidepressants within this age group

Suicide Among Baby Boomers

Baby boom generation -born between 1946-1964 -consistently higher suicide rates than previous or subsequent generations • 50 percent rate increase between 1999 and 2010 for people in their 50s • Suicide prevention programs typically focus on youths and older adults

Behavioral Symptoms in Depression

Behavioral symptoms such as fatigue, social withdrawal, and reduced motivation are common with depression. Some people who are depressed speak slowly or quietly; they may respond only in short phrases or not respond at all. Some appear agitated and restless, pacing and finding it difficult to sit still. They may cry for no particular reason or in reaction to sadness, frustration, or anger.

Etiological Considerations

Best understood through systems approach — social, psychological and biological factors interact in the development of eating disorders • The specific causal pathway may vary substantially from person to person

Typical Symptoms of Bulimia Nervosa

Binge eating-eating a substantially greater amount of food in a period of time (less than 2 hours) than most people would eat under similar circumstances -may be planned in advance or may begin spontaneously -most ashamed of their eating problems, and keep binges secret -during a bunge, the individual usuallyeays rapidly, until uncomfortably full - associated sene of lack of control over eating, sometimes dissociative • Often triggered by unhappy moods, and may be temporarily comforting

somatic symptom disorder Etiology: How it all comes together...

Biological (brain malfunction vs. structural abnormalities) § Psychodynamic (intrapsychic conflict, personality, and defense mechanisms) § Behavioral (modeling & reinforcement) § Environment (stress, sexual abuse, family separation/loss, family conflict/violence, & sexual assault) § Distorted cognitions (somatic amplification) § Inaccurate beliefs (prevalence of illness, symptoms, & treatment)

Biological Dimension DID

Biological explanations for dissociative disorders have focused on disruptions in encoding of memories due to acute stress and the inability to retrieve autobiographical material because of the release of hormones such as glucocorticoid, which may impede the recall of traumatic events (Bourget & Whitehurst, 2007). Atypical brain functioning in the structures associated with memory encoding and retrieval has been documented in various dissociative disorders (Arzy et al., 2011). In dissociative amnesia, MRI scans show inhibited neural activity in the hippocampus apparently associated with memory repression

What causes depressive disorders

Biological factors Social factors Psychological factors

Course and Outcome

Bipolar Disorders -onset between ages 28-33 -first episode equALLY LIKELY TO BE MANIC OR DEPRESSIVE -average manic episode lasts 2-3 months (shorter for Bipolar II) -Long term course episodic -Bipolar have more episodes than MDD -40-50% achieve sustained recovery - Rapid cyclers have poorer outcomes

Psychological Dimension Eating Disorder

Body image dissatisfaction/distortions low self-esteem; lack of control perfectionism or other personality charecteristics childhood sexual or physical abuse

Gender Differences

Both AN and BN are 10 times more common in females • Thought to reflect greater societal emphasis on looks and thinness in females • BED 2x more common in females than males

Bulimia nervosa is an eating disorder characterized by

Bulimia nervosa is an eating disorder characterized by

Family Problems

Bulimia-greater family conflict and rejection Anorexia- nonconflictual but enmeshed (overly involved in one another's life) -many report a history of sexual abuse, but not more often than women with other psychological problems

Definition of PTSD

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by avoidance or efforts to avoid one or more of the following: 1. distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s) 2. external reminders (i.e., people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about, or that are closely associated with, the traumatic event(s)

Cognitive Symptoms in Depression

Certain thoughts and ideas, including pessimistic, self-critical beliefs, are typical among people who are depressed. Rumination, continually thinking about certain topics or repeatedly reviewing distressing events, often occurs during a depressive episode. Ruminating can intensify feelings of depression, especially when it involves self-criticism, feelings of guilt, irrational beliefs, or other negative thoughts

PTSD: PSychotherapy (CBT) Cognitive Therapy

Cognitive Therapy • ID trauma-related beliefs linked to emotional and behavioral responses • Evaluate thoughts more logically • Determine if beliefs reflect reality, and if not, modify it

Suicide Among College Students

Comprehensive study of suicidal ideation in students at over 70 colleges -more than 50% reported suicidal thoughts -18% seriously considered attempting suicide -among these, 90-22% had a specific plan • Between eight and 14 percent had made an attempt • Approximately 80 percent of students who die by suicide did not seek professional help • 45 percent never tell anyone about their intentions • Some signs of suicidal risk • Verbalizing intentions • Withdrawal and depression • Giving away prized possessions

Somatic Symptom and Related Disorders

Conditions in which physical symptoms or concerns about an illness cannot be explained by a medical or psychological disorder

Effects of Suicide on Friends and Family

Consistent themes among surviving friends -guilt, and an attempt to understand the tragedy -altered relationships with friends -• Surviving family members, especially parents, often feel guilt and responsibility • Increased rates of depression, anxiety, alcohol abuse, and marital difficulty

Course and Outcome For BN

Current evidnce shows treatments are more effective for bulimia than anorexia -about 50% are free of all symptoms, 20% continue to meet diagnostic criteria • Comorbid psychological disorders appear to improve when bulimic symptoms end

Definition of PTSD

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following: 1. inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury, alcohol, or drugs) 2. persistent and exaggerated negative beliefs or expectations about oneself, others, or the world 3. persistent, distorted blame of self or others about the cause or consequences of the traumatic event(s) 4. persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame) 5. markedly diminished interest or participation in significant activities 6. feelings of detachment or estrangement from others 7. persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic numbing)

Acute Stress Disorder

DSM-4 people before they got PTSD

OBESITY

Defined as body mass index (BMI) greater than 30 • Second only to tobacco use as preventable cause of disease and death • Childhood obesity has a significant health impact, especially for girls • DSM-5 does not recognize obesity as a specific disorder - Obesity can be caused by binge-eating (BED, BN) - Obesity can lead to eating disorders (AN, BN) • In the US, 68 percent of adults were overweight as of 2012

Postpartum Depression

Depressed mood Lack of pleasure or interest sleep disturbance(insomnia or hypersomnia) Weight loss loss of energy agitation or retardation feelings of worthlessness or inappropriate guilt diminished concentration or indecisiveness frequent thoughts of death or suicide having thoughts about hurting self worrying about hurting baby

Looking for 5 of following symptoms

Depressed mood most of the day Loss of interest of pleasure Changes in appetite/weight Changes in sleep Psychomotor agitation or retardation changes in energy level fatigue feelings of worthlessness or guilt less able to concentrate recurrent thoughts about death

Mood disorders in DSM-5

Depressive Disorders:: Major depressive disorder persistent depressive disorder (Dysthymic disorder) Disruptive mood dysregulation disorder premenstrual dysphoric disorder Bipolar related disorders: Bipolar 1 Bipolar 2 Cyclothymia Bipolar disorder NED

somatic symptom disorder Developmental issues to consider...

Diagnostic criteria (consistent across all age groups) § Somatoform disorders (rare before adulthood) § Most common symptoms in adults

When is it Abnormal

Diagosis depends on clinicians judgement many inappropriate eating behaviors are normal -35% bing eat occasionally 29% fast after eating too much -8% use self-induce vomitting 5% use laxatives to compensate

Common Thinking Errors in Depression

Dichotomous or "all or nothing" thinking: 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 one c, I will never be a psychologist" Castrophizing: only paying attention to the dark side of things or overestimating the chances of disaster "I didn't get into an Ivy League School i'll never have a decent career" Personalizing: Taking things personally that have little or nothing to do with you "shes quiet she must hate me" Personal Ineffectiveness: Assuming you can do nothing to change your situation "jack always criticizes me, I wish he would quit"

Comorbid Psychologcal Disorders

Disorders associated with anorexia nervosa include: • Obsessive-compulsive disorder • Obsessive-compulsive personality disorder • Depression • They may play a role in the development of anorexia, but can also be reactions to starvation • Anorexia often, but not always, co-occurs with bulimia nervosa symptoms, such as binge eating and purging

§ Dissociative Disorders

Dissociative Identity Disorder § Dissociative Amnesia § Depersonalization/Derealization Disorder

Perceptual Distortions

Disturbance in perceiving or evaluating weight or shape -deny having problems with weight -distorted body image -unduly influenced

Socieconomic Stressors

During recession that began in 2008 -U.S. suicides increased by 1,580 from 2008-2010 During Greece's economic challenges -suicide rates increased by more than 60 percent risk factors -unemployment -bankruptcy

ECT

Electroconvulsive Therapy (ECT) -sedative -very effective when other treatments don't work -not a first result

Mania

Emotional Symptoms -Euphoria - Exaggerated feelings of physical and emotional well-being -On top of the world Cognitive Symptoms -Thoughts feel "speeded up" -Ideas appear faster than can be articulated -Easily distracted -Grandiosity and inflated self-esteem Behavioral Symptoms -Gregarious, energetic, restless -reduced need for sleep (weeks to months) Depressive episodes are longer than manic episodes

PTSD STATS

Epidemiology: 1) 39% of adults experienced traumatic stressor 2) 25% of these later develop PTSD • Rape more likely to cause PTSD than injury or accident • Lifetime prevalence is 10% for women and 5% for men

Definition of PTSD

Exposure to actual or threatened a) death b) serious injury or c) sexual violation, in one or more of the following ways 1)directly experiencing traumatic event 2)Witnessing in person, the traumatic events as they occured to others 3)learning that the traumatuc even was a close family member 4) repetead or extreme eposure to averusuve details of traumatic events like 1st responders

Typical Symptoms of Anorexia Nervosa

Fear of being fat -compulsive weighing Fear of loss of control -obsession with food -refusal to maintain a normal weight -below roughly 85% of expected body weight • High morbidity risk • 10% die of starvation, suicide, or medical complications

PTSD: Ex. of an In Vivo Hierarchy

Feared Situation Staying at home alone in the middle of the day, 50 Driving to a friends home in a safe neighborhood in daytime Driving to a friends house after dark -More

People who are diagnosed with _____ are typically overweight

binge-eating disorder

Real People, Real Disorders... The Piano Man

Found on the beach in a wet suit in Kent, England üNo identifying information üPlaced in the care of psychiatrists (to discover his identity and determine his medical condition) üDrew pictures of piano and later began to play the piano üAfter five months he revealed his identity Would this be considered dissociative fugue, factitious disorder, or malingering?

Social Factors in Major Depressive Disorder

Freud: Depression caused by loss of loved one Anger about loss is turned inward and becomes depression Lost relationship dependent, needed for self esteem Loss leads to conflicting feelings, ambivalence Difficulty understanding and expressing conflicted feelings

Depressive Disorders and Gender

Gender differences: Women 2-3 times more vulnerable ti depression than men Major Depression: Women 7%, Men 2.6% Dysthymia: Women 4.1%, Men 2.2%

Biological Obesity

Genetic influence on appetite thrifty geneotype dopamine receptors and pleasure in eating Ghrelin and leptin levels weight promoting intestinal bacteria slower metabolism

PTSD: a Worldwide Problem

Germany 1.3%, USA 7.8%, Ethiopia 15.8%, Cambodia 28.4%, Algeria 37.4%, Afghanistan 42.1%

Protective factors from suicide

Good emotional regulation, problem solving, and conflict resolution Willingness to talk about problems cultural and religious beliefs that discourage suicide Open to seeking treatment for mental, physical, or substance disorders family and community support connection to or responsibilty for children or pets resticted access to lethal weapons

Migraine, Tension, and Cluster Headaches

Headaches are among the most common stress-related psychophysiological complaints. About 90 percent of males and 95 percent of females have at least one headache during a given year. Among adolescents, headaches are common and more prevalent and severe in girls

Individuals who have the _____ type of anorexia are more likely to be extroverted.

binge-eating/purging

Suicide per 100,000

High in Russia, India, Africa -800,000 die every year

Occupational Prevalence: Hurting Professions

Higher than average suicide rates -physicians -highest, lowest among pediatricians -researchers speculate risk factors including burnout, stress, drug availability, and guilt over medical errors -Lawyers -Lawyer w/ mental health problems don't go for help since there history is available for everyone to see -Law enforcement personnel -Exposed to traumatic experiences/social expectations, PTSD -Dentist

Ethnic and cultural variables

Highest rate of completed suicides • American Indian/Alaska Native • European American males • Lower rates • African American • Hispanic/Latino • Asian American/Pacific Islander • Social change and disorganization may be a contributing factor

ALCOHOL: CULTURE

History of alcohol in US • Temperance movement (late 1800s/early 1900s), Prohibition (1920s- 1930s), AA founded (1935), cultural upheaval/substance use of 1960s and 1970s, drinking age 18 in late 1960s and back to 21 in late 1970s, Mothers Against Drunk Driving (1980s), concern about college drinking (1990spresent) • Cultural attitudes toward alcohol • Temperance and nontemperance cultures

Somatization Disorders (DSM-IV)

History of multiple distressing physical complaints and treatment-seeking before age 30. At least eight symptoms involving pain, gastrointestinal symptoms, sexual symptoms, and pseudoneurological symptoms. The symptoms or somatic complaints are "medically unexplained."

Biological Factors

Hormone fluctuations Hormonal contraceptives PMS and premenstrual dysphoric disorder PMDD Postpartum depression

Maladaptive Responses (Chronic Stress)

Hyperglycemia (diabetes) Hypertension, breakage of plaque in arteries Impaired immune response to illnesses Hypervigilance Global loss of interest in sex Increased focus on traumatic events, lack of attention to current environment Increased thickness of coronary artery walls (coronary vascular disease, strokes

Cognitive Response to Dissapointment

If rodents conditioned to not be successful they become more depressed and do less on the task.

PTSD: Psychotherapy innovations

Imaginal Rehearsal Therapy -Targets:Nightmares and Sleep disturbances Includes: focus on sleep hygene, cognitive restructuring, and imaginal exposure to the content of dreams Interapy (Internet and Therapy) -Write 10 essays over 5 weeks -4 exposure to trauma -4. cognitive appraisal -2. Closure to self/ significant others -Feedback through out therapy

Facts About Suicide

In the US, suicide is the 10th leading cause of death • Taboo topic: throughout history, people have avoided discussing suicide • Psychological autopsy • Systematically examining information after a person's death in effort to understand and explain behavior • Valuable tool for research on completed suicide • May not be helpful for understanding suicide motivation across cohorts

Adaptive Responses (Short-term Stress)

Increased glucose Increased blood pressure Increased immunity Increased vigilance Diminished interest in sex Improved cognition and memory Faster blood clotting

Suicide Among Military Veterans

Increasing rate of suicide i the military -349 deaths in 2012 more than the 295 combat-related deaths in Afghanistan during the sam period Factors contributing to risk: -Barriers to mental care in the military -PTSD -Frequent separation from family -Loss of comrads

Physiological Symptoms of Hypomania/Mania

Individuals experiencing hypomania or mania have high levels of physiological arousal that results in intense activity, extreme restlessness, or a need to be constantly "on the go." Increased libido (sex drive) often leads to reckless sexual activity or other impulsive behaviors. A decreased need for sleep is often the first sign of a hypomanic or manic episode; this sleep disturbance often escalates just before an episode and worsens during the episode

Behavioral Symptoms of Hypomania/Mania

Individuals experiencing hypomania or mania may seem uninhibited and act impulsively, engaging in uncharacteristic behaviors such as reckless driving, excessive drinking, illegal drug use, promiscuous behavior, uncontrolled spending, or making impulsive decisions such as changing jobs or developing plans to move to a new location.

When is it clinical depression vs. normal sadness

Intensity Absence of precipitants- happened out of the blue quality history associated features -somatic (fatigue, aches and pains, and headaches) and cognitive symptoms (thoughts of death and being worthless.

ETIOLOGY OF BINGE EATING DISORDER

Interpersonal distress (parents, peers, discrimination, etc.) • Some suffer emotional or sexual abuse during childhood • Disordered eating tends to run in families • Dopamine levels control appetite - People with lower levels desire food more • Other neurotransmitters and hormones involved - Serotonin, Ghrelin

Functional Impairment and Epidemiology

Lack of research § Impairment result of dissociative disorder or another psychological disorder § Inconsistencies in research reporting prevalence

Can Therapy Cause DID?

Letʼs examine the evidence... § Number of cases of DID rose from 79 in 1970 to tens of thousands in 2000 (after movie Sybil) § 80% to 100% have no knowledge of alters before therapy § Explanation: The correlation between alters, treatment, and the therapist awareness, and appropriate cues to produce DID § Conclusion: Post-traumatic model, therapistʼs expectations, Iatrogenesis,

BINGE-EATING DISORDER (BED)

Involves binging, feeling of loss of control, and marked distress over binge eating episodes • Eating until uncomfortably full or when not hungry • BED does not involve use of compensatory behaviors, such as vomiting, fasting, or excessive exercise • Diagnosis: history of binge-eating episodes at least once a week for three months

Dissociative Disorders: Real or Imagined?

Long-standing controversial diagnostic group § Definition: A set of disorders characterized by disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment § Five types of dissociative experiences § Depersonalization, derealization, amnesia, identity confusion, & identity alteration

Neurotransmitters and Depressive Disorders

Low levels of certain neurotransmitters, including serotonin, norepinephrine, and dopamine, are associated with depression. When our biochemical systems are functioning normally, neurotransmitters regulate our emotions and basic physiological processes involving appetite, sleep, energy, and libido; however, biochemical irregularities can produce the physiological symptoms associated with depression.

Mania vs. Hypomania

Mania is more extreme than hypomania. Hypomania doesn't go up as much, but lasts longer

PTSD Cultural

Many cultural groups affected by war, diease, and ethnic violence, poverty and sex trade Traumatic events can cause PTSD in children that can be chronic

Biological and psychological factors invlolved in dissociative dissorders

biological Psychological

Treatment: Bipolar Disorder

Medications -Lithium -has to be monitored, can blow out liver and kidney -Anti-convulsants -medication management Psychotherapy ECT- for depressive phase only

Suicide and microagressions

Microagressions are a covert form of everyday racism people of color experience varying amounts of microgressions microgressions are correlated with depression and suicidal thoughts

What is depression?

Mood-sustained feelings of disapointment and despair Symptom- sadness Clinical syndrome

PTSD Facts Regarding Countries

More in economic distress and poverty and less in industrialized countries

PTSD: PSychotherapy (CBT) Eye Movement Desensitization and Reprocessing

Most controversial • Eye Movement Desensitization and Reprocessing • Generate images/thoughts about trauma • Evaluate aversive qualities • Alternative cognitive appraisal while person follows the therapists finger with eyes

Psychological Obesity

Negative mood states binge-eating poor self esteem due to harrassment

Cycle of Depression

Negative thoughts, feelings, and behaviors perpetuate eachother

Psychological Factors in Major Depressive Dissorder

Not everyone who has a stressful life event becomes depressed. only 1 in 5 women with severe event becomes depressed- why? -vulnerability factors for women 1. lack of intimate confiding relationship 2. Severe young children at home 3. lack of employment away from home 4. loss of mother at early age

Not everyone who is diagnosed with bipolar I experiences _____.

Not everyone who is diagnosed with bipolar I experiences _____.

Can therapy cause DID? (dissociative identity disorder)

Number of cases of DID rose from 79 to 1970 to tens of thousands in 2000 (after movie sybil) 80% to 100% have no knowledge of alters before therapy explanation: the correlation alters, treatment, and the therapist awareness and appropriate cues to produce DID Conclusion: Post-traumatic model, therapist's expectations, latrogenesis, and sociocultural model

Alcohol Consumption

One of most consistent correlates -as many as 70% of suicide attempts involve alcohol • Strong correlation to successful attempt • May lower inhibitions related to fear of death • Alcohol-induced myopia • Focusing thoughts on the negative aspects of personal situations

Depersonalization/derealization disorder

Persistent changes in perception and detachment from one's own thoughts and body May feel things are unreal or a sense of being in a dreamlike state Intact reality testing About 2%; although 50-75% of adults may experience brief episodes of stress-related depersonalization Adolescence or adulthood May be short-term or chronic Dissociative identity disorder (multiple-personality disorder)

Circadian Rhythm Disturbances in Depression

Our circadian rhythms appear to play a role in physiological disturbances associated with depression, particularly seasonal depression (De Berardis et al., 2013). Circadian rhythms are internal biological rhythms, maintained by the hormone melatonin, that influence a number of our bodily processes, including body temperature and sleeping patterns. Depression is associated with disruptions in this system, both among those with and without seasonal patterns of depression.Circadian rhythm disturbances affecting sleep can increase risk of depression.

Social Dimension Eating Disorder

Parental attitudes and behaviors parental comments regarding appearance weight-concerned mothers history of being teaed about size or weight peer pressure regarding weight/eating

Physical Complications Bulimia

People with bulimia use a variety of measures—fasting, self-induced vomiting, diet pills, laxatives, and exercise—to control the weight gain that accompanies binge eating. Side effects from self-induced vomiting or from excessive use of laxatives include erosion of tooth enamel from vomited stomach acid; dehydration; swollen salivary glands; and lowered potassium, which can weaken the heart and cause heart irregularities and cardiac arrest (Nashoni, Yaroslavsky, Varticovschi, Weizman, & Stein, 2010). Other possible gastrointestinal disturbances include inflammation of the esophagus, stomach, and rectal area.

Illness anxiety disorder

Preoccupation with health and excessive worry about serious illness No somatic symptoms or very mild symptoms Excessive health anxiety Repeatedly checks for signs of illness or avoids medical contact for fear that illness will be confirmed According to the DSM-5, the primary characteristic of this disorder is a chronic pattern (at least 6 months) of preoccupation with having or contracting a serious illness or illnesses. In contrast with SSD, illness anxiety disorder involves minimal or no somatic symptoms. However, those with illness anxiety disorder are very anxious and easily alarmed about their health. This anxiety may result in excessive health-related behaviors such as continual checking of one's body for signs of illness, or avoidance behaviors

SUBSTANCES ASSOCIATED WITH ABUSE

Prescription medications • Used to treat anxiety, insomnia or pain • Legal substances • Examples: alcohol, caffeine, tobacco, and household chemicals • Illegal substances • Examples: methamphetamine, cocaine, and heroin

Risk Factors for suicide

Previous suicide intent, self injurious behavior, talk of suicide, dying, or self harm Substabce abuse, chronic pain or physical illness, insomnia, certain mental disorders Hopelessness, shame, humiliation, despair, anxiety/panic, self-loathing, impulsive aggressive tendencies Recent loss or significant traumatic event Relational conflict, lonleness, isolation Easy access to lethal weapons family turmoil Family members, pers, or favored celebrities have died from suicide

PTSD: non-CBT Approaches

Psychodynamic therapy -Expressive -Supportive _Psychodynamic-integrative -Effectiveness: needs empirical support Group Therapies -Utility 1, combat feelings of isolation adn 2. mutuality -type -supportive psychodynamic, -needs empirical support

Depression and Hopelessness

Psychological states most strongly associated with suicide -even mild depression increases risk -limted energy associated with severe depression makes suicide less likely • Psychache • Intolerable pain created from an absence of joy • Strongly associated with suicidal ideation

Psychological Dimension

Psychological theoretical explanations for somatic symptom and related disorders have focused on psychodynamic and cognitive-behavioral perspectives. Certain psychological characteristics have also been associated with these disorders.

Symptoms of Stress Psychophysiological Responses to Stress

Psychophysiological Responses to Stress • The adrenal glands release two key hormones. • Epinephrine (commonly known as adrenaline) and norepinephrine • This familiar "rush of adrenaline" further activates the sympathetic nervous system. • Cortisol, the "stress hormone" • The release of cortisol and CRF also cause immunosuppression, the decreased production of immune agents.

Symptoms of Stress

Psychophysiological Responses to Stress (continued) • Hans Selye defined the general adaptation syndrome (GAS) • Alarm • Resistance • Exhaustion

Symptoms of Stress

Psychophysiological Responses to Stress (continued) • Over time, physiological reactions to stress can leave you susceptible to illness. • Cannon hypothesized this occurs because intense or chronic stress overwhelms the body's homeostasis (a term he coined), the tendency to return to a steady state of normal functioning. • Over time, the prolonged arousal of the sympathetic nervous system eventually damages the body, because it no longer returns to its normal resting state.

Rate of PTSD

Rape, combat, molestation, assault, accident, and disaster

DSM-5 Classification with Binge Eating

Reccurent episodes of binge eating 1. over 2 hourse eating more food than most people 2. feeling out of control and associated with 3 or more 1. eating much more rapidly than normal 2. eating until uncomfotably full 3. Eating alone due to embarrassment 4. Feeling disgusted with self, depressed or guilty after • Marked distress when binge eating present • At least 1x per week for 3 months

repeatedly thinking or talking about concerns or events

Reduced connectivity between the hippocampus and the prefrontal cortex

Common reactions to trauma

Reexperiencing of the trauma, avoidance, hyperarousal or anxiety, dissociative symptoms, feeling cut off from others, feelings of foreshortened future, emotional numbing, sleeplessness, nightmares, intrusive memories, reminders of trauma, jumpiness, guilt and shame

Women and Stressful Life Events

Relationship btw. life events and depression

2 Sub-types of Anorexia Nervosa

Restricting type: includes people who rarely never binge eat or purge Binge eating/purging type involves regular binge eating and purging during a course of anorexia -people with this type are more likely to hav premorbid weight problems, problems with impulse control, and personality disorders some evident sugges this distinction may be less meaningful then originally thought

Prolonged Exposure can prevent PTSD in Immediate Trauma Survivors (Rothbaum)

Should wait a month -This research did fin improvements within 12 hours -Overall lower in following visits -Worked best for rape survivors -BEnefits if right kind of treatment

TREATMENT OF BINGE-EATING DISORDER

Similar to treatments for bulimia - Fewer physical complications presented - Include healthy approaches to weight loss • Two phases - Determine factors that trigger overeating - Learn strategies to reduce binges • CBT can produce significant reductions in binge eating • Medications to reduce appetite also used (i.e., Vyvance

Thought Restructuring

Situation: Got a C on a test for which I studied really hard Automatic Thought: I'm so stupid. I'll never get my degree Emotion: sad and discouraged New Thought: This was the first test- next time i'll be better prepared Outcome: Concerned but motivated to continue in class

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (4)

Sleep deprivation Endocrine disrupters - BPA (plasticizer bisphenol A) - Flame retardant polybrominated diphenyl ether (PBDE) - Numerous pesticides have been reported to affect hormone synthesis and/or metabolism - Industrial chemicals

Sociocultural Dimension Eating Disorder

Social comparison media presenting distorted images Cultural definitions and beauty objectification: female and male bodies evaluated through appearance

Social Dimension

Social stressors have been associated with impaired immunological functioning and other adverse health outcomes (Dickerson & Kemeny, 2004). A lack of social support can lead to immune system dysregulation with less natural killer cell activity and elevated inflammation (Jaremka et al., 2013). Childhood adversities such as physical, emotional, or sexual abuse are associated with headaches

Sociocultural Dimension

Sociocultural factors such as gender roles can have a major impact on health. For example, women have an increased likelihood of exposure to stressors associated with their role as caregivers for children, partners, and parents (Stambor, 2006). Additionally, woman are more likely to live in poverty and experience the sociocultural stressors and chronic disparities associated with having limited economic resources (L. Smith, 2010). Given the importance of social relationships for most women, social isolation is more likely to negatively affect the health of women. In a longitudinal study of men and women, high loneliness in women

Somatic Symptom & Related Disorders

Somatic Symptom Disorder § Illness Anxiety Disorder § Conversion Disorder § Factitious Disorder

Adjustment Disorder

Some issue happened in your life that made you want help, not necessarily traumatic

Defining Stress, Stress Appraisal

Stress as Appraisal of Life Events • Richard Lazarus defined stress by the individual's subjective appraisal of a challenging life event. • Primary appraisal is your evaluation of the challenge, threat, or harm posed by a particular event. • Secondary appraisal is your assessment of your abilities and resources for coping with that event.

Stress as a Life Event

Stress may be defined as a difficult life event regardless of the individuals reaction to it -Stressors can be positive or negative (eustress is good vs. Distress which is bad)

Can hormones can influence mental health?

Stress, Cortisol, Hormonal contraceptives, pregnancy testosterone

Dissociative amnesia, with dissociative fugue

Sudden confusion, e.g., wandering to a new area with inability to recall one's past and confusion about personal identity 0.2%; may increase during natural disasters or wartime which involves bewildered wandering or purposeless travel accompanied by amnesia for one's identity and life history. The following case study illustrates the extensive loss of personal identity that occurs during a dissociative fugue state.

Dissociative amnesia

Sudden inability to recall information of specific events or of one's identity or life history—results from stress or a traumatic event 1.8% in a community sample with 1% for males and 2.6% for females occurs when a traumatic event or stressful circumstances result in a sudden partial or total loss of important personal information or memory of a specific event (APA, 2013). An affected individual may be unable to recall information such as his or her name, address, or names of relatives, yet remember the necessities of daily life—how to read, write, and drive

Suicide and Specific Populations

Suicide among children and adolescents -15.8% of high school students seriously consider attempting suicide -7.8 percent had made an attempt in previous 12 months • Higher rates for female students than male • Hispanic/Latino and American Indian/Alaska Native females have highest rate of attempted suicides

Multipath Perspective of Suicide: Biological

Suicide influenced by low serotonin level in brain • 5-hydroxyindoleacetic acid (5HIAA) • Produced when body metabolizes serotonin • Low levels of 5HIAA in those who died from suicide • Genetics • Relationship is unclear • Certain endophenotypes associated with suicide

Suicide Effects on Children

Suicide of a parent can have lifetime effects -study looked at children who's parents died and found children who's parents died from suicide were 3 times more likely to commit suicide. -child has increased risk of developing mental health problems -increased risk of suicide especially if deceased parent was mother

Religious Affiliation

Suicide rate is lower in countries where the catholic church has a strong influence Islam also condemcs suicide -medical students in the United ARAB Emirates reported low lifetime prevalence of suicidal thoughts and attempts where religious sanctions against suicide are weak or absent, higher suicide rates are observed

Classification

Suptypes: Severity course specifiers: mild/moderate/severe With psychotic features Episodic specifers: With anxious distress with mixed features (some manic symptoms) psychotic mood congruent/incongruent melancholia peripartum onset seasonal pattern

Symptoms of PTSD

Symptoms begininf after event: 1) spontaaneous or cued recurrent, involuntary and intrusive distressing memories of trauma 2) recureent dreans 3) dissociative reactions (flashbacks) in which individuals feels or acts as if the traumatic events are recurrinv may result with complete loss pf awareness of present surroundings 4) intense or prolonged psychological distress 5) marked physiological reactions to reminders of the traumatic events

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (1) (MCALLISTER ET AL., 2005)

THE USUAL SUSPECTS Increased portion sizes in commercially marketed food items (increased restaurant dining) Inexpensive food sources such as fast food • Increased availability of vending machines with energy-dense (high calorie) items • Increased use of high fructose corn syrup • Less physical education in schools

Social Obesity

Teasing from family members or peers overweight friends parental attitudes regarding eating

Biological Factors

The body's response to dieting: -people have weight set points-fixed weights or small ranges of weight that the body tends to maintain • When food intake is reduced, there is a slowing in metabolic rate, the rate at which body expends energy as the body tries to compensate -genteic mechanisms -concordance rates for bulimia suggest some heritability: • 23% for MZ twins • 9% for DZ twins • This is possibly through the transmission of personality characteristics, including childhood anxiety, that increase risk for bulimia -neurophysiological measures associated with eating disorders: elevations in endogenous opioids • Low levels of serotonin • Diminished neuroendocrine functioning • These appear to be effects rather than causes

Somatic Symptom Disorder (DSM-5)

The existence of one or more somatic complaints. This is accompanied by at least one of the following: Persistent thoughts and concerns about the seriousness of the symptom(s) Chronically high levels of anxiety over health Spending excessive time or energy in regard to these symptoms

Suicide

The intentional, direct and conscious taking of one's own life -Has been extensively researched -risk factors and protective factors identified -strategies to successfully intervene identified -Of people who contemplate suicide, up to 90 percent have a mental illness -often indiagnosed Mental health factors particularly at high risk: -Depression -Bipolar disorder -Schizophrenia -Eating disorder -some anxiety and personality disorders esp, borderline personality disorder -substance use disorders

Emotional Symptoms in Depression

The most striking symptom of depression—depressed mood—involves feelings of sadness, emptiness, hopelessness, worthlessness, or low self-esteem. The following quote from a college student coming out of a deep depression illustrates the hopelessness and emotional numbness she was experiencing.

Psychological Dimension DID

The primary psychological explanations for the dissociative disorders come from psychodynamic theory, although individual vulnerabilities such as hypnotizability or suggestibility are also thought to play an important role. According to psychodynamic theory, dissociative disorders are caused by an individual's use of repression to block unpleasant or traumatic events from consciousness (L. F. Richardson, 1998). This process protects the individual from painful memories or conflicts. In dissociative amnesia and fugue, for example, memories of specific events or large parts of the individual's personal identity are no longer available to conscious awareness.

Social and Sociocultural Dimension

The sociocognitive model of DID takes both social and sociocultural factors into consideration. It was developed by Spanos (1994) and further elaborated by Lilienfeld, Lynn, Kirsch, and colleagues (1999). In this perspective, DID is conceptualized as displays of multiple role enactments that have been created, legitimized, and maintained by social reinforcement. Patients with DID synthesize these role enactments by drawing on a wide variety of sources of information, including the print and broadcast media, cues provided by therapists, personal experiences, and observations of individuals who have enacted multiple identities.

Sociocultural Dimension

There is a long history of sociocultural explanations for some somatic disorders. Conversion disorder, initially called hysteria, was originally viewed as a problem that afflicted only women; in fact, it derived its name from hystera, the ancient Greek word for uterus. Hippocrates believed that a shift or movement of the uterus resulted in complaints of breathing difficulties, paralysis, and seizures.

Emotional Symptoms of Hypomania/Mania

They also may be uncharacteristically irritable, have a low tolerance for frustration, and overreact with anger or hostility in response to environmental stimuli. People with mania exhibit unstable and rapidly changing emotions and mood, or emotional lability. Inappropriate use of humor, poor judgment in expressing feelings or opinions, and grandiosity (inflated self-esteem and beliefs of being special, chosen, or superior to others) can result in interpersonal conflicts and aggressive interactions.

Cycle of depression

Thoughts, behaviors, and feelings

Psychological Treatments SSD

Treatment for SSD and related disorders focuses primarily on understanding the client's view of his or her problem. Individuals with somatic symptom, illness anxiety, and conversion disorders are often frustrated, disappointed, and angry following years of encounters with the medical profession.

Treatments for Obesity

Treatments for obesity have included dieting, lifestyle changes, medications, and surgery. In general, dieting alone may produce short-term weight loss but tends to be ineffective in the long term; some individuals gain back more weight than was lost. Dieting may be somewhat more successful for children (Moens, Braet, & Van Winckel, 2010). T. Mann and colleagues (2007) concluded that most adults would be better off not dieting, because weight fluctuations create considerable stress on the body. The "yo-yo" effect in dieting (cycles of weight gain and loss) is associated with increased risk of cardiovascular disease, stroke, and decreased immune functioning. Among those with a genetic predisposition to obesity, physical activity can reduce the risk of becoming overweight

Biologic factors of Depressive disorders

Twin studies heritability for major depression is about 52% concordance rates higher for MZ twins than DZ twins Stressful events plus vulnerability thyroid dysfunction- reactions to stress neurotransmitters serotonin, norepinephrine, dopamine

Symptoms of Stress

Walter Cannon viewd stress as the activation of the fight or flight response -cannon observed however, that the fight or flight is maladaptive reaction to much stress in the modern world • i.e., being reprimanded by your boss or giving a speech before a large audience.

MDD with a seasonal pattern,

a condition involving at least two seasonal episodes of severe depression ending at a predictable time of year combined with a pattern of depressive episodes that occur seasonally more than nonseasonally (APA, 2013). Thus, the many people who experience milder seasonal depressive symptoms would not meet the DSM-5 criteria for MDD with a seasonal pattern.

iatrogenic disorder

a condition unintentionally produced by a therapist through mechanisms such as selective attention, suggestion, reinforcement, and expectations that are placed on the client. Could some or even most cases of dissociative identity disorder be iatrogenic? A number of researchers and clinicians say yes. They believe that many of the cases of DID and dissociative amnesia have unwittingly been produced by therapists

Ghrelin

a gastrointestinal hormone capable of stimulating hunger, regulating taste sensation, and increasing interest in food, is also a focus of research. When the appetitive circuitry is operating normally, ghrelin levels rise before meals and decrease after eating. Ghrelin works in conjunction with leptin, a hormone that signals satiety and suppresses appetite.

Rapid cycling

a pattern where there are four or more mood episodes per year, occurs in some individuals with bipolar disorder; this pattern is especially common among those who develop bipolar symptoms at an early age. Rapid cycling can be triggered by a variety of factors, including sleep deprivation and certain antidepressants (Fountoulakis, Kontis, Gonda, & Yatham, 2013). Rapid cycling increases the chance that the disorder will be chronic and that symptoms of mania, depression, and anxiety will be more severe

Hypertension

abnormally high blood pressure. a state of great psychological stress. in which the systolic blood pressure equals or exceeds 140 and the diastolic pressure is 90 or higher.

mood symptoms in depressive and bipolar disorders:

affect the person's well-being and school, work, or social functioning; continue for days, weeks, or months; often occur for no apparent reason; and involve extreme reactions that cannot be easily explained by what is happening in the person's life.

One of the most consistently reported correlates of suicidal behavior is _____.

alcohol consumption

selective amnesia

an inability to remember certain details of an incident. For example, a man remembered having an automobile accident but could not recall that his child had died in the crash. Selective amnesia is often claimed by people accused of violent criminal offenses; many murderers report that they remember arguments but do not remember killing anyone.

"psychache,"

an intolerable pain created from an absence of joy. Psychache has, in fact, been strongly associated with suicidal ideation, even more so than depression or hopelessness

Based on DSM-5 criteria, all of the somatic symptom and related disorders are associated with physical or bodily symptoms that _____.

are associated with abnormal thoughts, feelings, or behaviors

Migraine headaches

are associated with inflammation and dilation of cranial arteries; the pressure on nearby nerves and chemical changes within the brain produce pain (NINDS, 2012). Pain from a migraine headache may be mild, moderate, or severe. Most people with migraines report having them once or twice a month; 10 percent have them weekly, 20 percent have them every 2 or 3 days, and 15 percent have them more than 15 days a month

Tension Headaches

are produced when stress creates prolonged contraction of the scalp and neck muscles, resulting in vascular constriction and steady pain. They are the most common form of headache and tend to disappear once the stress producing the muscle tension is over (Singh & Crystal, 2013). The vast majority of adults experience tension headaches; additionally, about one third of children report having tension headaches (Monteith & Sprenger, 2010). Tension headaches are generally not as severe as migraine headaches, and can usually be relieved with aspirin or other analgesics.

Someone whose parent committed suicide is more likely to _____.

attempt suicide himself or herself

PTSD More symptoms- Persistent avoidance

avoidance of stimuli w/ the traumatic events especially of the following: 1) distressing memories, thoughts, or feelings, about or closely associated w/ traumatic events 2)

PTSD Negative alteration is cognitions and mood

begining or worsening after the traumatic events occured as evidence by two or more of the following: 1) inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia that is not due to head injiry, alcohol or drugs) 2) persistent and exaggerated negative beliefs or expectations about onesself, others or the world 3) persistent, distorted blame of ones self or otheers about the cause or consequences of the traumatic events 4) persistent negative emoptional state 5) markedly diminiahd interest or participation in significant activities 6) feelings of detatchment or enstrangement 7)

Researchers are currently working on _____ that would provide personalized medicine to revolutionize diagnosis and treatment of depressive and bipolar disorders.

biologically based diagnostic tests, and pharmacological and psychotherapeutic treatments

Mood disorders in clinical practice

broad category that includes disorders involving depression and mania two primary types of mood disorder Depressive (unipolar) Bipolar ( manic-depressive disorders) Defined in terms of episodesMost patients experience more than one episode

Someone who vomits, takes laxatives, and exercises excessively to avoid gaining weight would most likely be diagnosed with ___

bulimia nervosa

Those with illness anxiety disorder have a strong tendency to:

catastrophize and view ambiguous or mild somatic symptoms as indications of a severe or catastrophic illness; overgeneralize by believing that serious illness and fatal conditions are prevalent; display all-or-none thinking, such as believing they must be symptom free to be healthy; and show selective attention to medical information and focus primarily on threatening information (Fulton, Marcus, & Merkey, 2011). Those with illness anxiety disorder frequently check for signs of illness or disease, seek reassurance from others, continuously research and gather information on diseases, and avoid activities or circumstances they believe might result in an illness.

Asthma

chronic inflammatory disease of the lungs, can be aggravated by stress or anxiety. During asthma episodes, stress or other triggers cause excessive mucus secretion combined with spasms and swelling of the airways, which reduces the amount of air that can be inhaled (Figure 6.7). Symptoms range from mild and infrequent wheezing or coughing to severe respiratory distress requiring emergency care. In severe asthma attacks, respiratory failure can occur.

What therapeutic approach has achieved a 50% reduction (compared to traditional follow-up treatment) in repeat suicide attempts?

cognitive behavioral therapy

Depression responds best to

combination of psychotherapy and medication

Psychological Dimension

commitment—rather than allowing themselves to feel isolated and helpless, they became involved in the change process; control—they refused to feel powerless and attempted to influence decisions; and openness to challenge—they viewed changes within the company as opportunities (Maddi, 2002).

Mr. Houseman suffered a traumatic brain injury three years ago. Since that time, he has not been able to form new memories. He can remember things that happened prior to the injury, but he cannot remember anything that has happened since then. Mr. Houseman has _____ amnesia.

continuous

Tony was involved in a car accident that injured three of his friends. Tony was driving the car and when the accident occurred, he was texting. Since the accident, Tony has lost all motor control and feeling in his right hand up to his wrist. There are no indications of neurological or muscle damage. Tony is most likely to be diagnosed with _____.

conversion disorder

Sociocultural Dimension obesity

cultural influences on body prevalence poorer neighborhoods, less access to healthy foods advertising of high-calorie foods

European Americans tend to show decreased emotional reactivity when they are depressed, while Asian Americans are more likely to show increased physiological activity. This is an example of the effect of _____ on how depression is expressed.

cultural norms

For the past three years, Victoria has been feeling sad almost every day, but she does have periodic interludes of feeling energized and self-confident. The longest time she has gone without feeling "moody" has been six weeks. Her therapist has determined that her depression, while frequent, is mild, and her energized days do not reach the level of hypomania. Victoria is most likely to be diagnosed with _____.

cyclothymic disorder

The Durkheim Project is a computer based program that _____.

d. analyzes social media postings to estimate an individual's risk for suicide

People with PTSD are on a high alert for

danger

Juan is disturbed about the fact that he often feels as if he is not a real person living in a real world. He is not hallucinating. He sees the world accurately, but he feels as if he is a spirit moving through a dream. This feeling is beginning to affect how he relates to others. Juan is most likely to be diagnosed with _____.

depersonalization/derealization disorder

What is the disorder in which a disruption in an individual's identity produces two or more distinct personality states, and can also involve an experience of possession?

dissociative identity disorder

Research into how neurotransmitters affect eating disorders has largely focused on _____.

dopamine

anxious distress

during a depressive episode. For example, Antonio had difficulty functioning not only due to depressive symptoms, but also because of his persistent worry about his future.

Exposing females in South Africa and Fiji to Western cultural values has been associated with an increase in _____ in those countries.

eating disorders

Suicide rates in the United States are highest among _____.

elderly men

What is an FDA-approved and currently preferred treatment for profound depression?

electroconvulsive therapy

Typical side effects of bulimia nervosa include _____.

eroded tooth enamel, dehydration, swollen salivary glands, and gastrointestinal inflammation

Kallie has been crying for no particular reason for several months and has stopped going out with her friends In addition, her personal hygiene and grooming has become irregular at best. She has become uncharacteristically quiet and sometimes ignores her family's attempts to engage her in conversation. Lately, she has been feeling that she is a burden to her family and sees no hope for improvement in the future. The most important area of immediate concern should be whether Kallie is _____.

feeling suicidal

Dissociative disorders are _____.

heavily dependent on self-reports

An important component of treating somatic symptom and related disorders is to _____.

help the client manage his or her response to anxiety-producing conditions

long periods of unremitting depression and poor response to treatment

heredity

Suicide Rates by Race/ Ethnicity, 1990-2010

highest are white americans and native americans.

Biological Dimension What causes the development of SSD

hypervigilance or exaggerated focus on bodily sensation, increased sensitivity to even mild bodily changes, and a tendency to react to somatic sensations with alarm (S. Taylor, Jang, Stein, & Asmundson, 2008).

What condition is unintentionally produced in a client by a therapist's treatment strategies or interactions with the client (for example, by unconsciously encouraging or discouraging certain attitudes, behaviors, or beliefs with selective attention or reinforcing feedback).

iatrogenic disorder

Ginny's mother and grandmother both had strokes in their early 50s. Ginny turned 50 nine months ago. Since then, she has been extremely anxious about her health and the possibility of having a stroke, and she frequently looks for information about stroke causes and warning signs. She interprets every twinge and tingle that she feels as a possible sign of an impending stroke, but she refuses to have a checkup because she is afraid of what the tests might reveal. Ginny is most likely to be diagnosed with _____.

illness anxiety disorder

Etiology of Obesity

including genetic and biological factors; our sedentary lifestyle combined with easy access to attractive, high-calorie foods; and some of the same disturbed eating patterns seen in eating disorders. Thus, obesity is a product of biological, psychological, social, and sociocultural influences, as shown in Figure 10.5. How these dimensions interact is still a matter of debate. For example, one theory, termed the "thrifty genotype" hypothesis, points to the role of both genetics and the environment in accounting for the rapid rise in obesity.

SSRIs can help alleviate depression, but they have also been associated with _____.

increased suicidal thoughts and actions in some youth

Ghrelin is a gastrointestinal hormone that _____.

increases your interest in food

Somatic symptom disorder (SSD) is most prevalent in _____.

individuals of lower socio-economic status

More psychological factors in Major Depressive Disorder

interpersonal Factors and Social Skills Integration of Factors Vulnerability: -negative experiences -negative outlook onset: -triggered by life events maintenance: -activates negative cognitive schemas -depression drive away supportive -Cognitive Responses to Disappointment

Other social factors in Major Depressive Disorder

interpersonal stress -women more likely to be unsatisfied (women) -more likely to hold in things/stress and be more depressed (women) abuse and sexual assault lower social status and power -less control over life events (women) -make less money/ work more hrs (women) chronic stress stressful life events

Cluster headaches

involve an excruciating stabbing or burning sensation located in the eye or cheek. The attacks are extremely painful and have a very rapid onset (Bakbak, Gedik, Koktekir, & Okka, 2012). The symptoms are so severe that 55 percent of individuals experiencing a cluster headache report suicidal thoughts (Rozen & Fishman, 2012). Cluster headaches occur in cycles, and incapacitating attacks can arise several times a day (Meeks, 2004). In about 20 percent of cases, the headaches are preceded by an aura (Rozen, 2010). Each attack may last from 15 minutes to 3 hours before ending abruptly.

localized amnesia,

involves an inability to recall events that happened in a specific period, often centered on some highly painful or disturbing event. The following case study is typical of localized amnesia.

Persistent depressive disorder (dysthymia)

involves chronic depressive symptoms that are present most of the day for more days than not during a 2-year period (with no more than 2 months symptom-free). According to the DSM-5, dysthymia involves the ongoing presence of at least two of the following symptoms: feelings of hopelessness, low self-esteem, poor appetite or overeating, low energy or fatigue, difficulty concentrating or making decisions, or sleeping too little or too much

Cyclothymic disorder

involves impairment in functioning resulting from milder hypomanic symptoms that are consistently interspersed with milder depressed moods for at least 2 years. For this diagnosis, the depressive moods must not reach the level of a major depressive episode and the energized symptoms must not meet the criteria for a hypomanic or manic episode. Additionally, the person must experience mood symptoms at least half of the time and never be symptom-free for more than 2 months.

Prehypertension

involves increases in blood pressure (systolic pressure between 120 and 139 and diastolic pressure between 80 to 89) and is believed to be a precursor to hypertension, stroke, and heart disease

Depression

involves intense sadness or loss of interest in normally enjoyed activities. Depression is the core feature of depressive disorders. We can usually tell if someone is depressed because we notice changes in their emotional reactions, thinking, behavior, or physical well-being.

Conversion disorder (functional neurological symptom disorder)

involves motor, sensory, or seizure-like symptoms that are inconsistent with any recognized neurological or medical disorder and result in significant distress or impairment in life activities. Symptoms such as muscle weakness or paralysis, unusual movements, swallowing difficulties, problems with speech, seizures, or loss of sensation may be involved

Coronary heart disease (CHD) (Stress)

involves the narrowing of cardiac arteries due to atherosclerosis (plaque buildup within the arterial walls), resulting in complete or partial blockage of the flow of blood and oxygen to the heart, as seen in Figure 6.3. When coronary arteries are narrowed or blocked, less oxygen-rich blood reaches the heart muscle. This can result in angina (chest pain) or, if blood flow to the heart is significantly blocked, a heart attack.

aura

involving unusual physical sensations or visual symptoms such as flashes of light, unusual visual patterns, or blind spots—prior to the headache

Persistent complex bereavement disorder

is a condition undergoing study as a diagnostic category in DSM-5. This diagnosis would apply to individuals who have intense and persistent preoccupation or debilitating sorrow that continues for over a year after the death of a loved one. Those with persistent complex bereavement may also experience continued longing for the deceased, preoccupation with the way the person died, distress or anger over the death, or difficulty accepting the death. A diagnosis would require that the death have a significant effect on the person's interpersonal relationships or sense of identity

Dissociative identity disorder (DID), formerly known as multiple-personality disorder

is a disruption of identity as evidenced by two or more distinct personality states. According to DSM-5, those with DID have a disrupted sense of self and show alterations in behaviors, attitudes, and emotions when these alternate personality states occur. Recurrent gaps in memory for personal information or for everyday or traumatic events are also evident.

Stress Key Terms

is a negative emotional exp. accompanied by biochemical, psychological, cognitive and behavioral responses aimed at changing or adjusting to the stressor) • Stressor (any event that produces tension or other negative emotion, such as fear) • Appraisal process (assessment of whether a person has the resources or coping skills to meet the demands of a situation)

Mania

is a state of even more pronounced mood change involving extremely exaggerated activity levels and emotionality that impair normal functioning. Behaviors demonstrated during mania can range from extreme giddiness, excitement, and euphoria (exceptionally elevated mood) to extreme irritability, hostility, or agitation. Aside from hypomania being a milder version of mania, another notable difference is that manic episodes cause marked impairment in social or occupational functioning and may involve psychosis (loss of contact with reality)

hypomania

is characterized by increased levels of activity or energy combined with a self-important, expansive mood or an irritable, agitated mood. Someone with hypomania may appear quite distractible, change topics frequently, and have many ideas. The person may feel creative and start many projects, sometimes involving topics he or she knows nothing about. Impulsivity and risk taking may also appear during a hypomanic episode. The person may talk excessively or dominate conversations.

Obesity

is defined as having a body mass index (BMI) greater than 30. Our BMI, an estimate of our body fat, is calculated based on our height and weight. According to BMI standards, 68 percent of U.S. adults are overweight, which includes 35 percent who are obese. In the United States, the prevalence of overweight and obesity has doubled since the 1970s, and it is estimated that by 2015, 75 percent of adults and 24 percent of children and adolescents will fall into one of these categories.

Bipolar I disorder

is diagnosed when someone (with or without a history of severe depression) experiences at least one manic episode (see Table 8.6). For a diagnosis of bipolar I disorder, manic symptoms need to significantly affect normal functioning and be present most of the day, nearly every day, for at least 1 week. Manic episodes significantly interfere with common activities and interpersonal interactions.

Bipolar II disorder

is diagnosed when there has been at least one major depressive episode (see Table 8.3) lasting at least 2 weeks and at least one hypomanic episode (see Table 8.6) lasting at least 4 consecutive days. The behavior associated with hypomania often surprises, annoys, or creates concern in friends and family. As was the case with Daniel, those with bipolar II often fail to seek treatment until their mood swings and periods of depression begin to feel overwhelming.

anorexia nervosa

is extreme thinness. Individuals with this puzzling disorder starve themselves, relentlessly pursuing thinness, and detest weigh gain. Their body image is distorted (i.e., they see themselves as fat) and they deny the seriousness of the physical effects of their low body weight (National Institute of Mental Health, 2014).

Binge-eating disorder (BED)

is similar to bulimia nervosa in that it involves bingeing, an accompanying feeling of loss of control, and marked distress over eating during the episodes. To be diagnosed with BED, an individual must have a history of binge-eating episodes at least once a week for a period of 3 months. Additionally, those with BED also exhibit at least three of the following with binge-eating episodes: eating more rapidly than normal; uncomfortable feeling of fullness; eating large amounts of food even when not hungry; eating alone due to embarrassment about the quantity eaten; or feeling depressed or guilty after bingeing. Unlike bulimia nervosa, those with BED do not use compensatory behaviors such as vomiting, excessive exercising, or fasting

Depersonalization/derealization disorder

is the most common dissociative disorder. According to the DSM-5, it is characterized by recurrent or persistent symptoms of depersonalization (feelings of unreality, detachment, being an outside observer of one's own thoughts, feelings, or behaviors) and/or derealization (sense of unreality or dreamlike detachment from one's environment) that cause significant impairment or distress. During depersonalization/derealization episodes, the person remains in contact with reality (APA, 2013).

The primary distinction between bipolar I and bipolar II

is the severity of the symptoms during energized episodes. A bipolar I diagnosis requires at least one manic episode (including severe impairment that lasts at least 1 week); a bipolar II diagnosis requires at least one major depressive episode and one hypomanic episode, lasting at least 4 days (APA, 2013). Although you may have heard that bipolar II is a "milder" form of bipolar disorder, this is not accurate. The depressive symptoms associated with bipolar disorder can be as debilitating as the mood extremes see in bipolar I.

Emile Durkheim's theory of suicide supported the sociocultural dimension. She believed that the risk of suicide increases when an individual _____.

is unable to form connections and relationships with other people

The most common method of suicide by children under 15 is _____.

jumping from buildings or running into traffic

Sari is in the hospital after being rescued from a boating accident in which her brother died. For several hours, she denies having any memory of the accident or of her brother's death, and then suddenly became very emotionally agitated as she remembers what has happened. Sari has experienced _____ amnesia.

localized

Dysthymia is a lifelong disorder with _____.

long periods of unremitting depression and poor response to treatment

When bipolar disorder is comorbid with one or more other disorders, the individual is likely to have _____.

longer bipolar episodes

Clinicians sometimes use the unofficial term SAD to refer to _____.

major depressive disorder (MDD) with a seasonal pattern

Males and Eating Disorders

males diet for different reaosns -improve athletic performance -avoid being teased for having been a fat child -avoid getting medical diseases associated with males int he family -improve a gay relationship men with anorexia or bulimia may deviate from male norms and this may lead to rejection and stigmatization by others

Biological Dimension Eating Disorder

moderate heritability pubertal weight gain appetitive neural circuitry dopamine ghrelin and leptin

DSM-5 changed the diagnostic criteria for what was previously (in DSM-IV) known as somatization disorder. The new DSM-5 criteria for somatic symptom disorder (SSD) can reasonably be expected to result in _____.

more people being diagnosed with SSD

The long term recovery rate for binge-eating disorder is generally _____.

more positive than for anorexia nervosa

Cognitive Symptoms of Hypomania/Mania

ndividuals experiencing hypomania often display energized, goal-oriented behavior at home, school, or work. They may seem excited and talk more than usual, engage in one-sided conversations, and demonstrate little concern about giving others an opportunity to speak. They may have difficulty focusing their attention, show poor judgment, and fail to recognize the inappropriateness of their behavior. mpaired thinking may be apparent from their speech, sometimes referred to as pressured speech, which may be rapid, loud, and difficult to understand. Those experiencing mania frequently have extreme difficulty maintaining focus and display a flight of ideas; that is, they change topics, become distracted with new thoughts, or make irrelevant or illogical comments.

During the initial phase of treatment for anorexia nervosa, _____.

new foods are introduced that may trigger phobic reactions

A recent surge in suicides among military personnel is _____.

not well understood and is under investigation

Obesity researchers are finding increasing evidence that _____.

obesity is a complex challenge that is influenced by biological, psychological, social, and sociocultural factors

Depression and mania are _____.

opposite ends of a mood continuum

According to the _____ perspective, dissociative disorders are the result of repressing unpleasant or traumatic memories.

psychodynamic

Contrary to the dominant Western view that physical symptoms are often psychosomatic, many other cultures have a somatopsychic view. The somatopsychic view is that _____.

psychological and emotional symptoms are caused by physical problems

What is currently considered to be the most effective therapy for binge-eating disorder and tits associated weight issues?

psychological treatments

Bulimia Nervosa Inapproriate Compensatory behavior

purging-eliminating the consumed food from the body Sel-induced vomitting- the most common form of purging (90% of bulimics), it brings immediate physical relief and reduces fears of weight gain • Laxatives, diuretics, and enemas—less common forms of purging • None of the above forms of purging are is clearly effective in compensating for excessive intake • Excessive exercise and rigid fasting are alternative behaviors to purging

ventricular fibrillation

rapid, ineffective contractions of the heart -sudden unexplained death

Persuading mass media producers to promote a wide range of body types as healthy and attractive is expected to _____.

reduce body dissatisfaction and promote healthier lifestyles

Biological explanations propose that _____ might be a causal factor in dissociative disorders.

reduced volume in the hippocampus and amygdala

Mood

refers to our emotional state or our prevailing frame of mind. Our mood can significantly affect our perceptions of the world, sense of well-being, and interactions with others.

Rumination (and ruminating with others, or co-rumination) can increase the risk of depression, especially in girls. Ruminating is _____.

repeatedly thinking or talking about concerns or events

Researchers have found that individuals who have bipolar disorder share similar brain abnormalities and cognitive deficits with which other disorder?

schizophrenia

Suicide is now the _____ cause of death in college students.

second leading

The _____ allele of the serotonin transporter gene (5-HTTLPR) is associated with vulnerability to depression, especially in those who experience maltreatment during childhood.

short

What is a biological indictor that appears to be strongly correlated with higher rates of suicide and suicide attempts, while noting that a causal relationship has not been established?

sleep difficulties

bradycardia

slowing of the heartbeat

Higher suicide rates in countries that experience recessions, and among people who have declared bankruptcy, are unemployed, or have low incomes, is considered evidence of the influence of _____ stressors on suicide.

socioeconomic

psychogenic movement disorders

such as disturbances of stance and walking; sensory symptoms, such as blindness, loss of voice, or dizziness; and psychogenic seizures (Marshall et al., 2013). Among children and adolescents, the most common symptoms are motor weakness and abnormal movements (Ani, Reading, Lynn, Forlee, & Garralda, 2013).

tachycardia

tachycardia

blood pressure,

the measurement of the force of blood against the walls of the arteries and veins. Normal blood pressure is considered a systolic pressure (force when the heart contracts) lower than 120 and a diastolic pressure (the arterial pressure that occurs when the heart is relaxed after a contraction) lower than 80.

Co-rumination,

the process of constantly talking over problems or negative events with others, also increases risk for depression, especially in girls

An individual with _____ accomplishes weight loss through severe dieting or exercise.

the restricting type of anorexia nervosa

Relaxation training

therapeutic technique in which a person acquires the ability to relax the muscles of the body under almost any circumstances. Imagine that you are a client who is beginning relaxation training. You are instructed to concentrate on one set of muscles at a time—first tensing and then relaxing them. You might tightly clench your fists for approximately 10 seconds, then release the tension.

pure dysthymic syndrome

this category also includes individuals who have chronic symptoms of MDD. For many, dysthymia is a lifelong, pervasive disorder with long periods of depression, few periods without symptoms, and poor response to treatment. Dysthymia is often associated with negative thinking patterns and a pessimistic outlook on the future

suicidal ideation

thoughts about suicide—represent a distinct clinical condition warranting a unique diagnostic label

major depressive episode,

which involves severe depressive symptoms that have negatively affected functioning most of the day, nearly every day, for at least 2 full weeks (see Table 8.3). According to DSM-5, a major depressive episode involves a consistent pattern of depressed mood, feelings of sadness, or emptiness and/or loss of interest or pleasure in previously enjoyed activities.

systematized amnesia

which involves the loss of memory for certain categories of information. Individuals may be unable to recall memories of their families or of a particular person. In one case, shortly after the sudden death of her only daughter, an elderly woman appeared to have no recall of having had a daughter, but other memories were unaffected.

psychophysiological disorder

which references any physical disorder that has a strong psychological basis or component—instead of "psychological factors affecting other medical conditions." Emotional states, patterns of interpersonal interaction, and coping styles are just a few examples of how psychological factors can affect physical illness.

How do somatic symptom disorders impact individuals?

§ 10 to 15% of adults in U.S. report work disability as a result of chronic back pain § Only 33% of patients with conversion disorder work fulltime § People with somatoform disorders work on average 7.8 days less than everyone else § Remission rates § Medically unexplained physical symptoms make up 15-30% of PCP appointments § Doctor-shopping

Malingering...a crafty skill or a facade?

§ A condition in which physical symptoms are produced intentionally to avoid military service, criminal prosecution, or work, or to obtain financial compensation or drugs

Somatic Symptom Disorder

§ A. One or more somatic symptoms that are distressing or result in significant disruption of daily life § B. Excessive thoughts, feelings, or behaviors related to somatic symptoms or associated with health concerns as manifested by at least one of the following: § Disproportionate and persistent thoughts about the seriousness of oneʼs symptoms § Persistently high level of anxiety about health concerns § Excessive time and energy devoted to these symptoms or health concerns § C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

Treatment Factors involved in dissociative disorders

§ Antidepressants § Cognitive-behavioral therapy § Used to work on misinterpretation of normal symptoms of fatigue, stress, or even substance abuse § Challenge misinterpretations by teaching individuals to explore alternative explanations, "cognitive restructuring" § Exposure therapy to face fears

Biological and Psychosocial Factors Involved in Dissociative Disorders

§ Biological (abnormal brain functioning, structural abnormalities, neurochemical changes, and other neurological conditions) § Psychosocial (failure of normal personality integration, severely abused children, childhood sexual abuse, recovered or false memories, a method to "cope" or "block" a traumatic event, a way to "compartmentalize" trauma in the form of "alters," and viewed as an iatrogenic disease)

Sex, race, ethnicity & development

§ Both men and women suffer from dissociative disorders § May represent a Western "culture-bound syndrome" § Onset ranges from adolescence to early adulthood (16 to 23 years) § Children and dissociative disorders

Dissociative Fugue

§ Definition § A disorder involving loss of personal identity and memory, often involving a flight from a personʼs usual place of residence § Fugue means "flight" § Associated with physical or mental traumas, depression, or legal problems § Most likely to seek treatment after the realization of loss of identity or memory or if approached by the police

Depersonalization/Derealiza tion Disorder

§ Definition § Feelings of being detached from oneʼs body or mind, a state of feeling as if one is an external observer of oneʼs own behavior § Characterized by: § Incidence of comorbidity with other medical conditions or other psychiatric disorders § Feelings of being detached from oneʼs body or unfamiliarity with oneʼs surroundings

Illness Anxiety Disorder

§ Fears about having or acquiring a medical illness that persists despite medical reassurance § Dysfunctional mind-set - leads to worry about health and illness and excessive health checking behaviors § 78% percent experience comorbidity with anxiety disorder and major depression

Dissociative Identity Disorder (DID)

§ Formerly called multiple personality disorder (not to be confused with schizophrenia) § Media depiction § Definition § A presence within a person of two or more distinct personality states, each with its own pattern of perceiving, relating to, and thinking about the environment and self § Alternative personalities or "alters"

Factitious Disorder

§ Physical or psychological signs or symptoms of illness are intentionally produced in what appears to be a desire to assume a sick role § Involves falsification of symptoms, even in the presence of no external rewards § Factitious disorder imposed on self occurs as an individual imposes deceptive practices designed to produce signs of illness on self § Factitious disorder imposed on another occurs as an individual produces physical symptoms on another - normally mother imposing on a child

Somatic Symptom Disorde

§ Pierre Briquet (1796-1881) § Once called hysteria or Briquetʼs syndrome § The presence of many symptoms that suggest a medical condition, but without a recognized organic basis

somatic symptom disorder Treatment Options

§ Psychological § Basic education of the mind-body connection when it comes to symptoms (psychoeducation) § Cognitive behavioral therapy (CBT)

Are certain populations more at risk for somatic symptom disorders?

§ Sex, race, and ethnicity § Somatoform disorder is reported more frequently by women § Racial and ethnic differences

Trend in antidepressant use in children

• 2004 U.S. Food and Drug Administration warning of increased suicide risk for children taking SSRIs • Warning is required to be distributed with all such medication • Controversy over these actions • Effect of SSRIs on suicide rates is still unresolved • Medical professionals should monitor suicidal ideation

Prevalence of Suicidal Behavior

• About one million adults attempt suicide each year • One completed suicide for every 25 attempts • Ratio of attempts to suicides much greater for the young • Suicidal behavior and ideation begin with individual's initial suicide thoughts • Some people develop a plan • Smaller number attempt suicide • Suicide is third leading cause of death among college students • Actual suicide rate may be 25-30 percent higher than recorded • Some deaths deemed accidental may have actually been suicides

sexual symptoms in anorexia

• Amenorrhea—absence of at least three consecutive menstrual cycles (in women) • Many anorexic individuals lose interest in sexual activities • Fertility and pregnancy problems

DIFFERENT RACIAL AND ETHNIC GROUPS—ADULTS (NIH, 2012)

• Among Hispanic, Black, and White adults age 20 and older: - Overweight and obesity affect more than 3 in 4 Hispanics (78.8 percent) and Blacks (76.7 percent) - About 2 in 3 Whites (66.7 percent) are considered to be overweight or obese - About half of Blacks (49.5 percent), and more than 1 in 3 Hispanics (39.1 percent) and Whites (34.3 percent) are considered to be obese - Extreme obesity affects more than 1 in 10 Blacks (13.1 percent), and about 1 in 20 Whites (5.7 percent) and Hispanics (5 percent) • Rates of obesity among Asian Americans are much lower than among other racial and ethnic groups. (The following are general prevalence estimates from the 2010 NHIS for adults age 18 and older in these groups who reported being of one race.) - Asian Americans: 11.6 percent - American Indians and Alaska Natives: 39.9 percent - Native Hawaiians or Other Pacific Islanders: 43.5 percent

SUBSTANCE-RELATED DISORDERS

• Arise when psychoactive substances are used excessively • Psychoactive substances alter moods, thought processes, or other psychological states • Addiction • Compulsive drug-seeking behavior and loss of control over drug use • Withdrawal symptoms occur when discontinued

PREVALENCE OF WEIGHT CONCERNS AMONG YOUTH

• Attitudes regarding food and acceptable weight develop in home and community 1) very important not to be overwight girls 68.5% and boys 54.3%

Cultural Bound Syndrome?

• Beauty has become increasingly equated with thinness in our culture • Eating disorders are almost never seen outside North America, Western Europe, and industrialized Asian nations • "You can never be too rich or too thin" • Third world countries large size means beauty and success

COURSE AND OUTCOME OF BINGE-EATING DISORDER

• Begins in late adolescence or early adulthood • Remission rates higher than anorexia or bulimia • Weight may remain high

Family Problems

• Bulimia—greater family conflict and rejection • Anorexia—nonconflictual, but enmeshed (overly involved in one another's lives) • Many report a history of childhood sexual abuse, but not more often than women with other psychological problems

Suicide Crisis Intervention

• Can be highly successful for those who independently seek professional help • Or are encouraged to seek help • "No-harm" agreement • Written agreement between a suicidal person and therapist or person involved in crisis intervention • Lack of research supporting effectiveness • Temporary hospitalization

Prevention of Eating disorders

• Can eating disorders be prevented? • More successful prevention efforts do not directly focus on body image or disordered eating • Instead, they attack the thinness ideal indirectly, or focus on promoting healthy eating rather than eliminating unhealthy habits

DEPRESSANTS

• Cause nervous system to slow down • Alcohol • Moderate drinking • Lower risk patterns of drinking • No more than one drink for women or two drinks for men per day • Heavy drinking • Levels exceeding moderate • Binge drinking • Four to five drinks or more on a single occasion

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (6)

• Certain medications - Psychotropic medications - Antidiabetics - Antihypertensives - Steroid hormones and contraceptives - Antihistamines - Protease inhibitors

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (7) (

• Climate control • Bottlefeeding of babies - but PBDE found in breastmilk!

Clues to Suicidal Intent

• Clues may be demographic or specific • Specific clues • Previous suicide attempts • Having suicidal ideation or a suicide plan • Verbal communications of intent • Withdrawal, restlessness, changes in sleep patterns • Saying goodbye and putting affairs in order

Contemporary Trends and Future Directions

• Considering suicide as a psychiatric disorder in its own right • "Suicide behavior disorder" being studied • DSM-5 encourages therapists to ask about suicidal thoughts • Durkheim Project • Linguistic-based prediction models to analyzing postings on social media to estimate individual's suicide risk

Suicide Hotlines and Telephone Crisis Intervention

• Crisis requiring immediate preventive assistance can occur any time, day or night • Hotlines typically operate 24/7 • Numbers publicized throughout the community • Staffers are trained in crisis intervention techniques

Comorbid Dissorders Of BN:

• Depression is the most common, and may precede or be in reaction to bulimic symptoms • Anxiety disorders, personality disorders (especially borderline), and substance abuse also may cooccur with bulimia • Higher risk of suicide

TREATMENTS FOR OBESITY

• Dieting - Yo-yo dieting is ineffective long-term • Lifestyle changes • Medications • Surgery • Comprehensive intervention programs most promising

DSM-5 SUBSTANCE-USE DISORDERS

• Differentiated according to specific substance used • Substance-use disorder severity • Mild if two or three of designated symptoms present • Moderate if four of five are present • Six or more symptoms indicates severe disorder

EFFECTS OF SEDATIVES

• Drowsiness, impaired judgment, and diminished motor skills • Excessive use can lead to accidental overdose and death • Combining alcohol with sedatives increases danger • High potential for tolerance and physiological dependence • Withdrawal symptoms

DSM-5

• Eliminates distinction between abuse and dependence and replaces with "Substance Use Disorders" with specifiers • Need two or more of the following within a 12-month period: • Recurrent use results in failure to fulfill obligations • Recurrent use in hazardous situations • Continued use despite persistent or recurrent social/interpersonal impairment • Tolerance • Withdrawal • Substance often taken in larger amounts or over longer period than intended • Desire/unsuccessful efforts to cut down use • A lot of time spent trying to obtain, use, or recover from using • Activities given up/reduced because of use • Use continued despite knowledge of having problem because of substance • Cravings/urges • Moderate: 2-3 criteria; severe: 4+ criteria • Specify if with or without physiological dependence (tolerance/withdrawal) • Same course specifiers as DSM-IV

Multipath Perspective of Suicide: Sociocultural

• Emile Durkheim's sociocultural theory • Inability to integrate oneself into society • Lack of close ties deprives one of support systems necessary for adaptive functioning • Other sociocultural factors • Modern technological society • Alienation of lesbian, gay, bisexual and transgender youth

Eating Disorders and Culture

• Ethnoracial minorities less likely to suffer from anorexia nervosa • But minority women still feel social pressure to be thin • More positive body image among African American women • African American men prefer curvier figures • African American women may be at high risk for binge eating disorder • African American women have highest obesity rates

Gender

• Females have higher rates of suicidal thoughts and attempts • Death from suicide occurs much more frequently among males • 79 percent of all U.S. suicides • Males tend to choose most lethal methods • Drug overdose/poisoning most common means for women

SEDATIVES, HYPNOTICS, AND ANXIOLYTICS

• Have calming effects • Used to treat agitation, muscle tension, insomnia, and anxiety • Hypnotics: induce sleep • Anxiolytics: reduce anxiety • Barbiturates and benzodiazepines • Rapid anxiolytic effects in moderate doses • Hypnotic effects in higher doses

COURSE OF ALCOHOLISM

• High functioning alcoholics • Able to function without obvious disruption to their life • Often deny the problem or hide their drinking • Common for individuals to alternate between periods of excessive drinking and sobriety

Diagnosus of Stress and Physical Illness -Historically, the only physical illness thought to be affected

• Historically, the only physical illnesses thought to be affected by stress were a few "psychosomatic disorders," such as ulcers and asthma • Now we know that stress makes all mental and physical problems worse • DSM-5 has a separate section for coding stressors, such as psychosocial and environmental problems

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (1)

• Increased portion sizes in commercially marketed food items (increased restaurant dining) • Inexpensive food sources such as fast food • Increased availability of vending machines with energy-dense (high calorie) items • Increased use of high fructose corn syrup • Less physical education in schools

Adjustment Disorder

• Involve clinically significant symptoms in response to stress, but the symptoms are not severe enough to warrant classification as another mental disorder. • Similar to acute stress disorders and posttraumatic disorders, because stress causes all three conditions. • Can be a reaction to a stressor of any severity, not just traumatic stress.

BINGE-EATING DISORDER (CONT'D.)

• Lifetime prevalence - 3.5 percent of women - 2.0 percent of men • White women make up vast majority of those seeking treatment • Percentages of African American and white women with BED are roughly equal

ASSOCIATED CHARACTERISTICS OF BINGE-EATING DISORDER

• Likely to be overweight - 20-40 percent of those in weight-control programs have BED - Not all people with BED are overweight • Binges often preceded by poor mood, decreased alertness, feelings of poor eating control, and cravings for sweets • Complications - Type 2 diabetes, high blood pressure, and high cholesterol levels

ETIOLOGY OF OBESITY

• Many causes - Genetic and biological factors - Sedentary lifestyle - Easy access to attractive, high-calorie foods • Biological dimension - Some individuals have particular difficulty maintaining normal weight - Research implicates appetite-regulation neurocircuitry • Intestinal bacteria also under study

Multipath Perspective of Suicide: Social

• Many suicides are interpersonal in nature • Occur following relationship conflicts • Disconnection from friends, family, religious institution, or community • Increases susceptibility to suicide • Factors in children who consider suicide • Loss of significant parenting figure before age 12 • Abuse, and unpredictable traumatic events

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (3) (

• Maternal obesity and epigenetics - And heavier women have more children • Greater maternal age during childbearing • Positive assortment (mating) for adiposity

WHAT HAS CAUSED THE NATIONAL/ GLOBAL INCREASE? (2)

• Microbes (viruses, bacteria, and parasites) that cause obesity and insulin resistance - Inflammation - Natural infection of human adenovirus 36 (HAdV-36) is associated with human obesity - Chlamydia Pneumoniae is associated with higher BMI - Seropositivity to SMAM-1, an avian adenovirus, is associated with higher BMI

Social Factors

• More common in fields that emphasize weight and appearance, e.g., models, ballet dancers, gymnasts • More common in females who report greater exposure to popular media and who endorse more gender role stereotypes • More common in middle- and upperclass Whites, but increasing in African Americans of higher SES • Higher prevalence in Arab and Asian women living in Western countries than in their native countries

Posttraumatic Stress Disorder

• Most people recover from a trauma on their own • Some people continue to feel traumatized long after the event • When symptoms of trauma last more than 1 month, a person may be diagnosed with PTSD • When symptoms last a year, they are unlikely to get better on their own • Any change can be traumatizing

OPIOIDS

• Pain-killing agents that depress the central nervous system • Illegal substances • Heroin and opium • Prescription pain relievers • Morphine, codeine, and oxycodone • Considered gateway drugs, leading to use of more dangerous drugs • Highly addictive • Produce both euphoria and drowsiness

SOCIOCULTURAL DIMENSION OF OBESITY

• Some ethnic groups do not consider being moderately overweight a big concern - Larger body types preferred in some cultures • Higher obesity rates for those with lower socio-economic status - Limited availability of fresh fruits, vegetables, and grocery stores - Fast food cheaper than healthy foods - Reduced access to sports and exercise opportunities

Marital Status

• Stable marriage or relationship makes suicide less likely • For women, having children decreases suicide risk • People who are divorced, separated, or widowed have higher suicide rates than the married • Death of a spouse associated with 50 percent higher suicide rate for men

Symptoms of Stress Psychophysiological Responses to Stress (continued)

• Stress may both inhibit and enhance immune functioning. • Short-term stressors and physical threats enhance certain immune responses • Stress impairs other aspects of immune function, esp. actions that drain energy from the fight or flight response, and chronic stressors and losses also create immunosuppression.

PSYCHOLOGICAL & SOCIAL DIMENSION OF OBESITY

• Stress, anxiety, and depression • Responses are likely affected by weight stigma • Other risk factors - Physical and sexual abuse • Negative social interactions common among those with obesity - Weight-based victimization or discrimination - Stress within the family

SUBSTANCE ABUSE IN THE UNITED STATES

• Substance abuse • Excessive or harmful use of drugs and alcohol • Substance-use disorder • 8.5 percent of the population met the criteria in 2012 • Alcohol is the most commonly abused substance • Followed by marijuana, pain relievers, and cocaine

When Professional Help is needed w/ PTSD

• The traumatized person becomes depressed or suicidal • The traumatized person needs substances to cope with life • Trauma symptoms are getting worse or just not getting better

Working with a Potentially Suicidal Individual

• Three-step process • Know which factors increase likelihood of suicide • Determine probability that person will act on suicide wish (high, moderate, or low) • Implement appropriate actions

Psychotherapy for Suicidal Individuals

• Treatment often involves both medication and psychotherapy • CBT and DBT proven to reduce suicide risk by 50 percent compared to other forms of therapy • CBT focuses on vulnerabilities • DBT focuses on helping clients accept current lives and emotional anguish

CBT for Suicide Prevention

• Treatment program involves: • Chain analysis • Safety planning • Psychoeducation • Building hope and addressing reasons for living • Learning and using adaptive strategies from CBT and DBT to deal with specific problems

Course and Outcome of AN

• Treatments are not extremely effective • Follow-up treatment studies show: • normal weight in 50-60% • 10-20% significantly below weight • up to 10% may die • the majority remain preoccupied with diet, weight, and shape • Positive prognostic indicators include: • early onset • less parent-child conflict • early treatment • less weight loss • absence of binge eating and purging

Multipath Perspective of Suicide: Social (cont'd.)

• Two social factors strongly associated with suicide attempts (Joiner) • Perceived burdensomeness • Thwarted belongingness • Third factor: acquired capacity for suicide • Reduction in fear of taking one's own life • Repeated exposure to traumatic life events may lower this fear

TYPES OF EATING DISORDERS

• Types of eating disorders - Anorexia nervosa • Restricting • Binge-eating/purging - Bulimia nervosa - Binge-eating disorder • Obesity is not an eating disorder

CHILDREN & ADOLESCENTS (NIH, 2012)

• Young children ages 2-5 have a lower prevalence of overweight and obesity than older youth. • Among young people ages 2-19: - About 31.8% are considered to be either overweight or obese, and 16.9% are obese. - About 1 in 3 boys (33%) are considered to be overweight or obese, compared with 30.4% of girls. - About 18.6% of boys and 15% of girls are considered obese. • Among children and adolescents ages 6-19: - Almost 1 in 3 (33.2%) are considered to be overweight or obese, and 18.2% are considered to be obese. - More than 2 in 5 Black and Hispanic youth (more than 41%) are considered to be overweight or obese. - About 25.7% of Black, 22.9% of Hispanic, and 15.2% of White youth are considered obese

Common Reactions to Trauma

•Reexperiencing the trauma •Avoidance •Hyperarousal or anxiety •Dissociative symptoms • Feeling cut-off from others or isolated • Feelings of a foreshortened future • Emotional numbing • Sleeplessness •Nightmares •Intrusive Memories •Reminders of the Trauma • Jumpiness •Guilt • Shame