Abnormal Psychology

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What Triggers a Suicide?
Suicidal acts may be connected to recent events or current conditions in a person's life. Although such factors may not be the basic motivation for the suicide, they can trigger it.
Common triggers include stressful events, mood and thought changes, alcohol and other drug use, mental disorders, and modeling.
Long-term suicide stressors can include:
•Serious illness -especially those which cause great pain or severe disability.
•Abusive environments from which there is little or no hope of escape.
•Occupational stress.
The "four-letter word" in suicide is "only," as in "suicide was the only thing I could do"
- key that they can't find options.
Dichotomous thinking:
black and white thinking.
Mood and Thought Changes w/ suicide
Many suicide attempts are preceded by changes in mood. These changes may not be enough to warrant a diagnosis of a mental disorder. The most common change is a rise in sadness. Increases in feelings of anxiety, tension, frustration, anger, or shame are also common. People who attempt suicide may experience dichotomous thinking, viewing problems and solutions in rigid either/or terms.
Underlying Causes of Suicide:
The Biological View
Family pedigree and twin studies support the position that biological factors contribute to suicidal behavior.
For example, there are higher rates of suicide among the parents and close relatives of those who commit suicide than among nonsuicidal people. Serotonin levels have been found to be low in people who commit suicide. There is a known link between low serotonin and depression. One possibility is that low serotonin activity may contribute to aggressive and impulsive behaviors.
Children & suicide:
• Suicide is infrequent among children
• Rates have been rising for the past several decades
• More than 6% of all deaths among children between the ages of 10 and 14 are caused by suicide.
• Boys outnumber girls by as much as 5:1
• Suicide attempts by the very young generally are preceded by such behavioral patterns as running away, temper tantrums, social withdrawal, dark fantasies, and marked personality changes.
• Despite common misperceptions, many child suicides appear to be based on a clear understanding of death and on a clear wish to die.
Adolescence & suicide
• About half of teen suicides have been tied to clinical depression, low self-esteem, and feelings of hopelessness
• Anger, impulsiveness, poor problem-solving skills, substance use, and stress also play a role
• Some theorists believe that the period of adolescence itself produces a stressful climate in which suicidal actions are more likely
• Far more teens attempt suicide than succeed.
• Ratio may be as high as 200:1
• Teen suicide rates vary by ethnicity in the U.S.
• Young white Americans are more suicide-prone than African Americans at this age. Suicide rates are growing closer.
The elderly & suicide
In Western society the elderly are more likely to commit suicide than people in any other age group.
There are many contributory factors:
• Illness
• Loss of close friends and relatives
• Loss of control over one's life
• Loss of social status
Elderly persons are typically more determined than younger persons in their decision to die, so their success rate is much higher.
Suicide risk assessment:
1. Current intent
2. Do they have a plan?
3. How (selected method)? Access to means?
4. Where? When?
5. Reasons, recent stressors, humiliations
6. History of suicidal behavior
7. Previous attempts; how did they get help?
8. Diagnoses
90% completers have psychological diagnoses
60% completers have existing mood disorder
Depressive symptoms - hopelessness
9. >6x increase of attempts if another family member attempted
10. Substance use/abuse.
Alcohol associated with 25-50% of suicides.
Adolescents: 1/3 suicides due to drug use and intoxication
11. Social support
Top three most important Q's in a suicide risk assessment:
1. Current intent
2. Do they have a plan?
3. How (selected method)? Access to means?
Warning signs of suicide:
• Loss of loved one or failure at something
• Talking about suicide
• Dramatic changes in mood or behavior
• Changes in sleeping, eating, and personal hygiene
• Loss of interest in enjoyable activities
• Preoccupation with death
• Increased risk-taking (drugs/alcohol)
• "Cleaning house" - giving away possessions
• Saying goodbye
Suicide: Terms to know - Completers
successful at killing self
Suicide: Terms to know - Attempters
tried but survived;self-injurious behavior with intent to die.
Suicide: Terms to know - Ideation
thinking seriously about killing self
Suicide: Terms to know - Morbid thoughts
thoughts about death, but not of killing self
Suicide: Terms to know: Gesturers
self- injurious behavior W/OUT intent to die.
Purpose to communicate, manipulate.
May kill themselves by mistake
What Is Suicide Prevention? General Approach-
The general approach includes:
• Establishing a positive relationship
• Understanding and clarifying the problem
• Assessing suicide potential
• Assessing and mobilizing the caller's resources
• Formulating a plan

o Although crisis intervention may be sufficient treatment for some suicidal people, longer-term therapy is needed for most.
o Another way to prevent suicide may be to limit the public's access to common means of suicide
Examples: gun control, safer medications, and car emissions controls
What Treatments Are Used After Suicide Attempts?
After a suicide attempt, most victims need medical care
Psychotherapy or drug therapy may begin once a person is medically stable. Many suicidal people fail to receive psychotherapy after a suicide attempt.
Therapy goals:
• Keep the patient alive.
• Help them achieve a nonsuicidal state of mind.
• Guide them to develop better ways of handling stress
Various therapies and techniques have been employed.
Cognitive and cognitive-behavioral therapies may be particularly helpful.
Patterns and Statistics of Suicide
The suicide rates of men and women differ:
Women have a higher attempt rate (3x men)
Men have a higher completion rate (3x women)
Different methods have differing lethality.
Men tend to use more violent methods (shooting, stabbing, or hanging) than women (drug overdose.)
Suicide is also related to social environment and marital status.
One study found that half of the subjects who had committed suicide were found to have no close friends.
Divorced people have a higher suicide rate than married or cohabiting individuals.
Suicide facts -
Suicide is a leading cause of death in the world
There are about 700,000 people who die from it each year, with more than 31,000 suicides per year in the U.S. alone.
Many more (600,000 in the U.S.) unsuccessfully attempt suicide than actually succeed.
Major risk factor for suicide attempts is past attempts.
Social isolation, number of supportive people around is a key risk factor. Impulsivity and poor problem-solving skills are key factors.
Suicide facts-
It is difficult to obtain accurate figures on suicide rates, and many investigators believe that estimates are often low
Many "accidents" may be intentional deaths
Since suicide is frowned upon in our society, relatives and friends often refuse to acknowledge it.
Suicide is not classified as a mental disorder in the DSM-V
While suicide is often linked to depression, about half of all suicides result from other mental disorders or involve no clear mental disorder at all.
In rare tragic cases, a mother suffering from major depression with peripartum onset sometimes...
kills her child
Recent evidence indicates a higher level of ___________ in patients with bipolar disorder that was marked by a rapid cycling pattern compared to those with a non-rapid cycling pattern.
suicide
Suicide associated with bipolar disorder almost always occurs during
depressive episode
Which of the following is TRUE of depression in the elderly?
The prevalence of depression is almost equal among elderly men and women.
Which of the following statements about suicide is correct?
For teenagers, suicide is the third leading cause of death after auto accidents and homicide.
Statistics on suicide indicate that approximately one-quarter to one-half of all suicides are associated with _____________.
alcohol use
Which of the following statements is accurate regarding the relationship between anxiety and depression?
Many depressed patients are or have been anxious and many anxious patients are or have been depressed.
All of the following statements are accurate about electroconvulsive therapy (ECT) except
psychotically depressed patients should be treated with ongoing medication, not ECT, even when response to those drugs is poor.
The antidepressant medication lithium is also referred to as a mood stabilizer because it
helps to prevent manic episodes
In Aaron Beck's depressive cognitive triad, individuals think negatively about all of the following EXCEPT ______
their past
With regard to social support
having social support helped speed recovery from depressive episodes
Which of the following is perhaps the best-known and widely used SSRI medication
Prozac
Which of the following statements is TRUE about tricyclics?
They can be accompanied by very unpleasant side effects.
Mood within normal limits vs. mood outside normal limits
How do you determine this?
Intensity
Duration
Impairment/interference in functioning
Outside cultural/social norms
Mood Episodes are...
building blocks for a mood disorder
Mood Episodes : (3)
Major Depressive Episode
Manic Episode
Hypomanic Episode
Mood Disorders: (4)
Major Depressive Disorder
Persistent Depressive Disorder
Bipolar I and II Disorder
Cyclothymic Disorder
Major Depressive (MD) Episode :
5 or more of the following during the same 2 wk period.
Depressed mood by report or observation
Anhedonia -loss of interest or pleasure
(one or both must be met)
Significant weight loss/weight gain or significant changes in appetite.
Sleep problems
Psychomotor agitation or retardation
Fatigue/loss of energy
Feelings of worthlessness or excessive guilt
Problems with concentration
Suicidal ideation
(5 or more)
Symptoms do not meet criteria for mixed episode.
Cause clinically significant distress or impairment.
Are not due to direct effects of substance or medical condition.
R/O Grief
Major Depressive (MD) Episode Occurs :
5 or more of the following during the same 2 wk period.
Manic Episode Occurs: (A)
Period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 wk (unless hospitalized).
Also increased goal -directed activity.
Manic Episode: (B)
B. 3 or more symptoms (during A):
o Inflated self esteem, grandiosity
o Decreased need for sleep (e.g., after 3 hours sleep)
o Pressured speech, very talkative
o Racing thoughts (flight of ideas)
o Distractibility
o Increase in goal -directed activity or psychomotor agitation
o Excessive involvement in pleasurable activities that could result in troubling consequences
Cause significant impairment or makes hospitalization necessary, or there are psychotic features
Not due to a substance or medical condition
Hypomanic Episode :
("below manic episode" / less extreme)
Same as manic episode,
EXCEPT that the mood lasts at least 4 days.
Unequivocal change in fx that is uncharacteristic of person and observable by others.
Not marked by impairment or need for hospitalization.
Not due to substance or medical condition.
The structure of Mood Disorders :
(Unipolar/Bipolar)
Unipolar:
Depression OR mania
At one pole of a mood continuum
Bipolar:
Both depression AND mania

Misleading terminology bc not just ONE mood continuum
▪ Person can experience mania and feelings of depression and anxiety -
mixed manic episode/ dysphoric mania
Depressive Disorders: Major Depressive Disorder (MDD):
either
Single episode or
Recurrent - presence of 2 or more MD episodes
Not better accounted by other diagnoses
(e.g., Schizophrenia, Schizoaffective Disorder)
Never a manic or hypomanic episode.

Mean age onset - 30 yrs.
Incidence increasing from previous decades
Duration: average first episode 4 - 9 months (if untreated)
Episodes can last from 2 wks to several years.
Residual symptoms increase risk for future episode(s)
Depressive Disorders: Persistent Depressive Disorder:
Depressed mood for most of the day, on most days, for at least 2 years (1y in children/adol.)
Milder than MDD, fewer symptoms, but stable course (lasts longer)

Onset before 21 yrs. associated with:
1.Greater chronicity (lasts longer)
2. Poor prognosis and response to treatment
3. Stronger likelihood of disorder running in family

As many as 79% of ppl with PDD have also had a MD episode at some point. More likely to attempt suicide than individuals with major depression
(in a 5 yr period).
Depressive Disorders: Double Depression
Major Depressive Episodes with preexisting
Persistent Depressive Disorder
More severe, chronic course
Bipolar I
Alteration of major depressive episodes with FULL MANIC episodes.
Avg. age of onset approx. 18 yrs.
Severe mood instability as a result of symptoms.
Often a high degree of job, work, or school impairment.
Risky behaviors can be highly dangerous to the individual and sometimes others.
Bipolar II
Alteration of recurrent major depressive episodes with hypomanic episodes (so, not at same time)
A. presence/ hx of one or more MD episodes
B. presence/hx of at least one hypomanic episode
C. NEVER a manic episode
D. Crit A and B not accounted by another dx
E. Clinically significant distress or impairment
10 - 13% will develop into BP I
Avg. age of onset between 19 and 22
Cyclothymic Disorder
At least 2 years (1 year in children/adolescents) of hypomanic symptoms (not full hypomanic episode) and depressive symptoms (not full MDD episode)

More than half of two years, not w/o symptoms for 2 months.
Not severe enough to require hospitalization or severe intervention. "Moody" to the point that it interferes with fx.
At increased risk to develop bipolar disorder.
Not better accounted for by substance or general medical condition.
Full criteria for MDD, manic, or hypomanic episode never met.
Bipolar Disorders History:
Duration: Usually life - long
Even with treatment
16% recover; 52% suffer from recurrent episodes; 16% chronically disabled; 8% commit suicide

Medication is almost always indicated to stabilize mood!
Course of Mood Disorders
Salient Specifiers in DSM- V:
• Rapid cycling: 4 or more episodes in one year = rapid cycling
• Seasonal patterns
• With Anxious Distress
• With Mixed Features ; uncommon
Prevalence of Mood Disorders
12 Month Prevalence (in US):
MDD = 7%
PDD = 0.5%
Bipolar I: 0.6%
Bipolar II: 0.8%
Cyclothymic Disorder: 0.4% - 1.0% (lifetime)

Across Cultures:
More somatic symptoms
Subjective feelings difficult to study and compare
Socioeconomic Status (SES) confounds findings and is a risk factor (have more stressors in life)
Causes of Mood Disorders
1. Biological Dimensions
2. Psychological Dimensions
3. Sociocultural Dimensions
Familial and Genetic Influences:
Biological Vulnerability
• Family studies
Rate is 2- 3 times higher in relatives of probands (i.e., the person known to have the dx)
• Twin studies
(Identical twins share the exact same genes. They're monozygotic)
If one has it, identical twin 2- 3x's more likely than frat. Twin to also have mood d/o (partic bipolar)
Severe mood disorders (severe MDD) have a stronger genetic contribution than less severe
Heritability rates are higher for females compared to males.
Familial and Genetic Influences:
Biological Influences
•Neurotransmitter systems (chemical messengers allowing different nerve cells or neurons to communicate w/ one another)
Low levels of serotonin in its relation to other neurotransmitters (NTs) Norepinephrine and dopamine (low levels)
•Permissive hypothesis -
When serotonin low, other NTs are "permitted" to range more widely, become dysregulated, and contribute to mood irregularities
•The endocrine system
Stress hypothesis - Elevated cortisol levels ("stress" hormone)
Psychological Dimensions: Cognitive Theory of Depression
Negative coping styles.
Depressed persons engage in cognitive/thinking errors.
Tendency to interpret life events negatively.
Depressive cognitive triad:
1. Think negatively about oneself
2. Think negatively about the world
3. Think negatively about the future
Depressive cognitive triad:
1. Think negatively about oneself
2. Think negatively about the world
3. Think negatively about the future
Psychological Dimensions (Stress)
Diathesis- stress model:
Diathesis- stress model:
Stressful, severe, traumatic life events strongly related to
Onset of depression
Poorer response to tx
Longer time before remission
Context and meaning of life events important!! Same event may mean different things to different people (e.g., divorce)
Not all stressful events are independent of depression
In ~1/3 of cases, stress does not precede depression
Bipolar disorder:
Stressful events trigger early mania and depression
Can trigger relapse or prevent recovery
Lack of sleep may precipitate manic episodes
Disturbed circadian rhythms (e.g., jet lag)
Psychological Dimensions: Cognitive Theory of Depression: Learned Helplessness
Depressive attributional styles maintain symptoms
Interpretation of negative events:
1. Internal attributions: Negative outcomes are "all my fault"
2. Stable attributions: situation/future will "always be this way"
3. Global attribution: "just like everything else"
All three domains contribute to a sense of hopelessness
Depressive attributional style for positive events
External - not because of me, luck
Specific - just this situation
Unstable - will never happen again

Maladaptive assumptions:
Ideas about what one thinks they SHOULD be doing.
"I should get the approval of everyone"
Negative self-concept: Focus on shortcomings, exaggerate them, minimize positive qualities. See self as unlovable, ugly, weak.
Psychological Treatment of Mood Disorders
Interpersonal Psychotherapy (IPT)
Emphasizes ID and resolution of interpersonal problems and stressors. Ex: death of loved one, divorce.
Learn to form important new relationships
Cognitive Behavioral Therapy (CBT)
ID and modification of distorted thoughts, feelings, and maladaptive behaviors
Sociocultural Influences
Marital relations- Marital dissatisfaction is strongly related to depression.
Particularly strong in males .
Disruption found to precede depression
Mood in women.
Females over males for MDD and PDD (70%)
Bipolar disorders evenly divided.
Gender imbalance likely due to sex roles & perception of uncontrollability for females.
Social support-
Lack of s.s. is related to onset of depression
10% of women who had close friend developed vs.
37% of who did not have supportive friend
Goal of Cognitive Behavioral Therapy:
Event → thoughts → feel → behavior
• Increase logical thinking
• Understand relationship: how we think about or interpret events determines the way we respond emotionally and behaviorally
• Cogns intervene in how we feel about events; Events do not directly influence how we feel. Instead, the way we think about those events does.
• Thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate difficulties in another
Revising cognitions and behaviors in CBT:
If cognitions determine feelings → revising illogical cognitions can → more appropriate emotional reactions → more adaptive behaviors.

If cognitions are more extreme than warranted, unwanted feelings and maladaptive behaviors can unnecessarily occur

Steps to revising cognitions:
1. ID illogical cognitions (automatic thoughts)
2. Challenge them
3. Replace them with more logical cognitions
4. Do behavioral experiments to test/confirm the more logical cognition
Psychological Tx: Bipolar disorder
Psychotherapy can help manage how disorder interferes w/ daily life.
• Can help regulate sleep cycles and daily schedules
• Increase family support and understanding of pt to help prevent relapse
Medication compliance essential
• Clients may sometimes skip during manic episodes
• Self-monitoring log
Psychotropic Treatment of Mood Disorders
Antidepressants
Selective serotonergic reuptake inhibitors (SSRIs)
Lithium (lithium carbonate)
Primary choice of drug for bipolar disorder
Often effectively treats manic episodes
50% respond well
Potentially severe side effects, must carefully be followed by physician
Electroconvulsive Therapy (ECT) (biological treatment)
For severe depression w/no response to other less invasive tx's.
Brief (<1s) electric shock to brain leading to convulsions lasting few min.
6-10 tx's, once every other day
50% benefit, ~60% of cases relapse

stressful events are strongly related to the onset of bipolar d/o and depression.
The physical symptoms of a major depressive disorder include
changes in appetite or weight.
One of the symptoms of a mood disorder is called anhedonia, which means
an inability to engage in pleasurable activities.
Most individuals who experience a single episode of major depressive disorder will
probably have several episodes throughout their lives.
When manic episodes alternate with depressive episodes, the disorder most correctly diagnosed would be
bipolar disorder
Bipolar II disorder consists of
depression and hypomanic episodes
Symptoms of severe depression are generally NOT considered a psychological disorder when they are associated with ____
a greif reaction
Recent research suggests that
the same genetic factors contribute to both anxiety and depression.
A child raised by depressed parents is likely to
struggle with depression as well.
Martin Seligman's theory that people become anxious and depressed because they believe that they have no control over the stress in their lives is called
learned helplessness theory
According to recent research on the development of depression, dysfunctional attitudes (a negative outlook) and hopelessness attributes (explaining things negatively) constitute a _____________ vulnerability to depression.
cognitive
A student who has been doing very well in her psychology class receives a minor critical comment on an essay that she wrote as part of an exam. The student thinks, "This is terrible. I'm probably going to fail the course." This type of cognitive error in thinking is called ____
overgeneralization
Eating Disorders: (3)
Severe disruptions in eating behavior.
Extreme fear and apprehension about gaining weight (Preoccupation with thinness) with AN and BN.
All marked with difficulty controlling eating behaviors

1. Anorexia nervosa (AN)
2. Bulimia nervosa (BN)
3. Binge-eating disorder
Anorexia Nervosa
An eating disorder in which a person is obsessed by thoughts of an unattainable image of "perfect" thinness
Anorexia Nervosa: Diagnostic Criteria:
A. Significantly low weight due to energy intake restrictions.
Severity is specified by current BMI (mild, moderate, severe, extreme)
B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain even when underweight.
FASTING.
C. Distorted idea of body image, denial of seriousness of current weight.
Anorexia Nervosa (2 types)
Anorexia: Two subtypes
1. Restricting
Limit caloric intake via diet and fasting
No recurrent binging/purging in the past 3 months.

2. Binge-eating/purging
(Binge- eating large amnt of food within short amnt of time)
Laxatives, self-induced vomiting, diuretics.
Eat smaller amounts of foods and purge more frequently than those with bulimia. Binging or purging in the past 3 months.
Anorexia Statistics
12 Month prevalence rates
• 0.4% of population among females
• >90% adolescents and young adult females (typically higher SES(higher income bracket))
• About 10% males
More chronic and resistant to treatment compared to bulimia. Successful weight loss hallmark of anorexia- different than bulimia because of ability to keep weight off and very low BMI.
Not only dealing with physiological lack of intake but also real psychological variables at play w/ hospitalization.
Anorexia: Medical Consequences
• Dry skin
• Damage to teeth and hair loss
• Damage to vital organs (heart and brain)
• Pulse rate and blood pressure drop
• Nutritional deprivation causes calcium loss from bones, which can become brittle and prone to breakage
• Can cause infertility (hormonal imbalance)
• Lanugo-downy hair on limbs and cheeks lol
• Death from starvation (15 -20%)
Anorexia:
(Comorbidity- having 2+ diagnosable disorders)
Anxiety and mood disorders often present.
Depression in 33% of current cases; 60% experience it at some point in life.
*OCD most common anxiety disorder that co-occurs with anorexia.

Intrusive thoughts about weight gain, body image
Preoccupation with food -cooking for others, constantly talking about it, hoarding it.
Behaviors often ritualistic.
Excessive control of food intake.
Strict and excessive exercise regimens; obligatory.
Bulimia Nervosa
An eating disorder characterized by binges on large quantities of food, followed compensatory behaviors to make up for binge.
More common than anorexia.
Bulimia: Diagnostic Criteria
A. Recurrent episodes of binge eating characterized by both:
Eating an amount of food in a discrete period of time (e.g. 2 hours) that is larger than most people would eat during a similar period of time and under similar circumstances.

30 times the calories for a single meal.
Sense of lack of control of what is eaten during the episode.

B. Recurrent inappropriate compensatory behavior to prevent weight gain. Provides equilibrium (rid of shame, guilt, disgust), temporary relief, hunger, and restriction again.

C. Binge eating and inappropriate compensatory behaviors both occur at least 1x a week for 3 months (on average)

D. Self-evaluation unduly influenced by body shape and weight
Distorted body image.

E. The disturbance does not occur exclusively during episodes of anorexia
Bulimia: Subtypes
Severity depends on number of inappropriate compensatory behaviors per week
(mild, moderate, severe, extreme)
Medical consequences: Bulimia
(Even when normal weight)
• Intestinal problems from laxative abuse.
• Electrolyte imbalance and dehydration can occur and may cause cardiac complications.
• Rare instances, binge eating can cause the stomach to rupture
• Heart failure due to the loss of vital minerals like potassium
• Calluses in back of hand from induced vomiting (gag reflex)
• Erosion of dental enamel due to stomach acid
• Kidney failure, cardiac arrhythmia, seizures, permanent colon damage
Binge-eating disorder (BED)
Now an official diagnosis in DSM-V
Engage in food binges without compensatory behaviors
(^different from bulimia because!)
Associated features
• Many persons with B-ED are heavier or obese
• Concerns about shape and weight
• Often older than bulimia and anorexia pts
• More psychopathology vs. non-binging obese people
Binge Eating Disorder Criteria
A. Recurrent episodes of Binge Eating (Binges are the same as other eating disorders) that includes a lack of control and large amount of food w/in discrete time period.
B. Other symptoms (3 or More):
-Eating much more rapidly than normal
-Until uncomfortably full
-Eating large amounts of food when not physically hungry
-Eating alone due to embarresment
-Feeling disgusted w/ oneself, depressed/ very guilty afterward.
C. Marked distress regarding binges
D. Binges occur at least 1x a week for 3 months
E. BE does not occur exclusively during AN or BN and is not associated with recurrent compensatory behavior
Causes of Bulimia and Anorexia:
Media and cultural considerations
Being thin = success, happiness....really?
Cultural glorification of thinness (Western cultures)
Standards of ideal body size
Change constantly, as much as fashion!
Media standards of the ideal
Cultural Considerations of Bulimia and Anorexia:
ED's more prevalent among females
Compared to Caucasians, prevalence lower among African American and Asian females
Equal to Hispanics
More common among Native Americans
Cultural factors influence rate of ED's
Inc. prev. of ED's is related to changes in cultural standards of thinness. Acceptance of bigger body sizes in some cultures may contribute to lower incidence of ED's
African American adolescents
Body Image Dissatisfaction
Males tend to rate ideal body weight as heavier
Women rate current body figure as heavier than what they thought would be most attractive
Discrepancy between cultural ideals and current self may lead to: depression, self-doubt, low self-esteem
Psychological and Behavioral Considerations of Bulimia and Anorexia:
• General psychological vulnerabilities
• Learn inappropriate coping skills when faced with stress
• Low sense of personal control and self-confidence
• Perfectionistic attitudes
• Distorted body image perception
• Preoccupation with food
Medical and drug treatments-
Bulimia & Anorexia
Bulimia-
Antidepressants (Prozac)
Can help reduce binging and purging behavior
Are not efficacious in the long-term
Anorexia-
No drug has been found effective
Medical intervention likely needed to restore nutrients, fluid. VERY psychologically driven
Bulimia: Psychosocial treatments
CBT is the treatment of choice
• Normalize eating patterns: meal planning
• Self-monitoring of food intake, binges, purges
• Psychoeducation about the disorder and its potential consequences
• Expanding food choices, adding "forbidden" foods
• Cognitive restructuring -distorted thoughts of food intake, weight, shape, self
• Problem solving; adaptive coping skills
• Weight and shape concerns, body image dissatisfaction
• Relapse prevention

CBT produces better and more immediate outcomes in the short-term compared to other txs
Similar long-term effects as IPT
Interpersonal psychotherapy (IPT) (for ED)
At first, discuss relationship between interpersonal events and the ED
Eventually, focus shifts to (problematic) interpersonal relationships, as these can lead to negative affect that triggers binge eating.
Results in long-term gains similar to CBT
Psychological Treatment of Anorexia Nervosa
General goals and strategies
Weight restoration
• First and easiest goal to achieve, but poor predictor of outcome
• Medical intervention recommended when weight is <70% of expected wt
Behavioral and cognitive interventions
• Target food intake, body image perceptions
• Dysfunctional attitudes about body shape, anxiety about weight gain, uncontrollability, self-worth
Tx often involves the family
Long-term prognosis for anorexia is poorer than for bulimia
Treatment of Binge Eating Disorder
CBT
Similar to that used for bulimia
Appears efficacious
IPT: Interpersonal psychotherapy
(focuses on interpersonal relationships and functioning)
Equally as effective as CBT
Self-help techniques
Also appear effectious.
An Integrative Model (ED)
No single cause of ED's.
Combo of biological, psychological, and sociocultural factors influence the development of ED's.
ED's share similar biological and psychological vulnerabilities as mood and anxiety disorders.
Although the "alarm reactions" experienced in both PTSD and panic disorder are very similar and result in conditioned responses, in panic disorder the alarm is __
false
An individual who suffers from panic disorder might become anxious about climbing stairs, exercising, or being in hot rooms because these activities produce sensations similar to those accompanying a panic attack. In psychological terms, the exercise and hot rooms have become __
conditioned stimuli
anxiety is closely related to
depression
Anxiety is thought to be a____________ state, while fear is more______
future-oriented; immediate
For generalized anxiety disorder (GAD), the pharmacological treatment of choice has been the category of drugs known as _______
benzodiazepines
In regard to a type of thinking pattern found in some patients with OCD, which of the following would be an example of thought-action fusion?
Believing that thinking about an abortion is the moral equivalent of having an abortion
Individuals suffering from posttraumatic stress disorder (PTSD) display a characteristic set of symptoms including all of the following EXCEPT
decreased startle response and chronic under-arousal.
Mrs. Pan has an anxiety disorder in which she has occasional panic attacks when shopping at the mall. This type of panic attack is referred to as _________
cued
People tend to have their best performance on tasks when they are _____
a little anxious
People with GAD tend to worry about
mostly minor things.
People with a psychological vulnerability to panic attacks tend to ________ normal physical sensations.
catastrophize
Research suggests that anxiety and depression frequently
co-occur
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